(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Report of the Health Department of the Panama Canal for the calendar year"



REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1930 

Gift of the Panama Canal Museum 




J. F. SILER 

Colonel, Medical Corps, United States Army 
CHIEF HEALTH OFFICER 



BALBOA HEIGHTS, CANAL ZONE 



THE PANAMA. CANAL PRESS 

MOUNT HOPE, C. Z. 

1931 



REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1930 




J. F. SILER 

Colonel, Medical Corps, United States Army 
CHIEF HEALTH OFFICER 



BALBOA HEIGHTS, CANAL ZONE 



THB PANAMA CANAL PRESS 
MOXJNT HOPE, C. Z. 

1931 




For additional copies of this publication address The Panama Canal, Washington, D. C. 
or Balboa Heights, Canal Zone. 



CONTENTS. 

Page. 

1. Title. 1 

2. Organization and activities 5 

3. Personnel 7 

4. Financial statement , 1 1 

5. Vital statistics populations of the Canal Zone, Panama City, and Colon.. . 12 

(1) General death rates, all causes and from disease only: 

Canal Zone._ 15 

Panama City .^ 17 

Colon..._ 18 

(2) Birth rates: 

Canal Zone 20 

Panama City _ 21 

Colon 22 

(3) Infant mortality rates: 

Canal Zone - .-. 24 

Panama City : .'. 24 

Colon... ._ _.. _ 24 

(4) Principal causes of death : 

Canal Zone. 24 

Panama City 25 

Colon. 26 

(5) Acute transmissible diseases reported in 1930 26 

6. Vital statistics, Panama Canal employees 28 

(1) Death rates, all causes _ 29 

(2) Death rates, disease only 30 

(3) Principal causes of death 31 

(4) Admission rates to hospitals and quarters 31 

(5) Principal causes of admission to hospital 32 

(6) Noneffective rates, all causes.- 33 

(7) Admission rates, malaria 34 

(8) Amission, death, and fatality rates, malaria, by race 37 

(9) Death rates, malaria 38 

7. Division of Hospitals, Dispensaries, and Charities 40 

(1) Annual Report, Gorgas Hospital, 1930 41 

(2) Annual Report, Colon Hospital, 1930 _ 56 

(3) Annual Report, Corozal Hospital, 1930 64 

(4) Annual Report, Palo Seco Leper Colony, 1930 71 

(5) Annual Report, Dispensary Service, 1930 72 



CONTENTS— Continued. 

8. Division of Sanitation : Page. 

Organization and activities 73 

Routine and special activities undertaken during 1930 77 

Routine activities 77 

Special projects undertaken in 1930. ...',.. 77 

Preliminary investigation of malaria in the Madden Dam area.. 77 
Malaria surveys of construction gangs and treatment of those 

infected 78 

Identification of new species of mosquitoes 78 

Trypanosomiasis in animals 78 

Experiments in composting manure..._ 79 

Disposal of garbage, Pacific entrance to the Canal 80 

Special projects undertaken in Northern District 80 

Special projects undertaken in Southern Division — Pedro 

Miguel, Ancon-Balboa, and Panama-Suburban Districts 81 

Health services in the terminal cities, Panama and Colon _. 82 

Annual Report, Health Officer, Panama City.... 84 

Annual Report, Health Officer, Colon 94 

9. Division of Hygiene... 95 

10. Report of the District Nurse 100 

11. Division of Quarantine 101 

General Tables: 

28. Discharges from hospitals, deaths, and noneffective rates for em- 

ployees 105 

29. Causes of deaths of employees arranged with reference to color, 

age, and length of residence on Isthmus _ 106 

30. Deaths and death rates of residents of the Canal Zone and the 

cities of Panama and Colon 108 

31. Deaths of residents of the Canal Zone and the cities of Panama and 

Colon, by cause, sex, color, age, and place of residence 110 

32. Deaths of nonresidents by cause, sex, color, and age 116 

33. Statistics regarding American employees and their families 118 

34. Discharges and deaths in hospitals of The Panama Canal 118 

35. Consolidated hospital and colony report 124 

36. Number of days hospital treatment furnished various classes of 

patients and average number in hospital each day... 125 

37. Consolidated admission report, hospitals and dispensaries._ 125 



CALENDAR YEAR REPORT, 1930. 
HEALTH DEPARTMENT. 

ORGANIZATION AND ACTIVITIES. 

The Health Department of The Panama Canal is one of the five 
main departments of The Panama Canal organization functioning 
directly under the Governor. It is charged with sanitation and the 
control and prevention of transmissible diseases in the Canal Zone 
and in Panama City and Colon, the treatment and hospital care of 
United States Government employees and their dependents, and others 
entitled to such care, the enforcement of quarantine regulations and 
the compilation of vital statistics for the Canal Zone and the cities of 
Panama and Colon. 

Its activities are conducted under the four principal divisions indi- 
cated in the organization chart on the following page. 

The administrative officers in charge of hospitals and dispensaries 
report directly to the Chief Health Officer. The Assistant Chief 
Health Officer, in addition to his general supervisory activities as 
Assistant Chief Health Officer, has direct charge of the Division of 
Sanitation. The Division of Quarantine is directly supervised by the 
Chief Quarantine Officer, an assistant in the office of the Chief Health 
Office. The Division of Hygiene is supervised by one of the assistants 
to the Chief Health Officer— at the present time by the Chief Quaran- 
tine Officer; its activities consist of the visiting nurse service, maternal 
and infant welfare, and physical examination of school children. 

CHIEF HEALTH OFFICE, ORGANIZATION, 

The office of the Chief Health Officer, Assistant Chief Health Ofificer,* 
and Chief Quarantine Officer, is in the Administration Building, Balboa 
Heights, and owing to the consolidation of the various classes of work 
of the several departments of The Panama Canal, the clerical force 
consists of but one office assistant, one clerk, and one payroll keeper. 
Accounting for property is handled by the Property Bureau of the 
Governor's office; all personnel records and papers pertaining thereto, 
are handled by the Personnel Bureau; vital and population statistics 
are prepared in the Bureau of Statistics; general correspondence is filed 
in the Record Bureau. This consolidation eliminates an enormous 
amount of duplication of work on the part of The Panama Canal organ- 













U 




O 






•7^^ 


u. 




ujO 




n 


M^ 


m^m 




EX 




<^ tf 


UH; 




to = 






< >^ 


UJ 




E 


X 




U 



















5'jt 


















t-O 






























S< 








z 


^2 




ss 




OZ 


"s 






y-* 




<a < 


^5 

So 






n 




ii 


>5 




















o 




1 1 



JruJ JO 

< 2 5_i 

U OS „ «: lO 

O 0-<„-5f 



bd 
















z 
















o 








P 


O 








z« 




E 




Kul 




_iki 

?5 






o 


-| 




l-> 






3r! 


z 










afO 




sJo 


o 




























eS 
















> 






o 




ZU 




ts 




1 




1 




1 



XX^ 



:i * 3 

it3 Ig % 

32 Ss fS 

SK S5 35 

go 1° uo 



iif^ 


































f^p 


















































ii 

ii 

ii 


n 




& 

a. 
O 

8 




a: 

i 

z 

2 
o 
o 




Ok 




si 

Ok 

_1U1 

^3 




< 

Z 
ul 

a. 

5 


o 


r 
O 
< 


O 

3 

3 

Q 
a. 


<: 

o 


C 

s 








1 




1 




1 













.7 



ization, and while records and figures are not quite as readily accessible 
as would be the case were all the work done in the Chief Health Office, 
various memorandum files which are necessary for immediate reference 
in regard to personnel, statistics, and other records, are kept in the 
office, and in this way the work is handled very satisfactorily. 



PERSONNEL. 

As the tour of duty of officers of the Medical Corps of the Army 
assigned to The Panama Canal for duty in its hospitals is ordinarily 
a three-year one, the usual changes incident to termination of tour of 
duty have occurred in such personnel. 

Col. Arthur M. Whaley, Medical Corps, U. S. Army, was appoint- 
ed Superintendent, Gorgas Hospital, April 13, 1930, vice Col. George 
M. Ekwurzel, relieved from duty with The Panama Canal. 

The strength of the personnel constituting the Health Department 
at the end of the calendar year as compared with the two preceding 
years, was as follows: 

FORCE REPORT, HEALTH DEPARTMENT. 



Chief Health Office.... 

Gorgjis Hospital 

Colon Hospital 

Corozal Hospital 

Line Dispensaries 

Palo Seco Leper Colony 

Quarantine service 

Health Office, Panama. . 
Health Office, Colon... 
Zone Sanitation 

Total 



December 31, 1930. 



Gold. 



7 
167 
29 
22 
16 

1 
11 
11 

9 

6 



Silver. Total 



267 
54 

141 
15 
18 
20 

118 
87 

117 



279 



837 



7 

434 
83 

163 
31 
19 
31 

129 
96 

123 



1,116 



1929. 



7 

475 
77 

103 
27 
38 
33 

139 
97 

117 



1928. 



5 

425 
62 

147 
23 
38 
37 

135 
93 

129 



1,094 



The distribution of white personnel at the end of the year based on 
professional or other qualifications was as follows: 



33 physicians, medical officers of the 

U. S. Army. 
1 physician, surgeon of the U. S. 

Public Health Service. 
29 physicians, civilian. 

1 dentist, civilian. 
10 internes. 

9 male staff nurses. 
105 female staff" nurses. 

2 district nurses. 
33 clerks. 

12 sanitary inspectors. 

1 sanitary assistant. 

2 quarantine inspectors. 
6 veterinarians. 



8 technicians 

7 dispensary assistants. 

5 pharmacists and assistant 

macists, 
2 chemists. 
2 general mechanics. 

2 stewardesses. 

3 dietists. 

1 storekeeper. 

1 dental hygienist. 

1 vaccinator. 

1 carpenter foreman. 

1 chauffeur foreman. 

1 physio-therapy aide. 



phar- 



8 

The individuals filling the higher positions on December 31, 1930. 
and their respective duties, were as follows: 

CHIEF HEALTH OFFICE. 

Balboa Heights. 

Col. Joseph F. Siler, Medical Corps, U. S. Army, Chief Health Officer. 
Dr. Dalferes P. Curry, Assistant Chief Health Officer. 
Surg. Marion F. Haralson, U. S. P. H. S., Chief Quarantine Officer. 
Mr. Arthur L. Fessler, Office Assistant. 

Gorgas Hospital. 

Col. Arthur M. Whaley, Medical Corps, U. S. Army, Superintendent. 

Maj. John W. Sherwood, Medical Corps, U. S. Army, Assistant to Superintendent. 

Mr. Elmer F. Ohlson, Executive Assistant. 

Dr. Troy W. Earhart, Chief of Surgical Service. 

Dr. Howard K. Tuttle, Assistant Chief of Surgical Service. 

Maj. Henry C. Dooling, Medical Corps, U. S. Army, Chief of Medical Service. 

Maj. Forrest R. Ostrander, Medical Corps, U. S. Army, Assistant Chief of Medical 

Service. 
Maj. Laurent L. LaRoche, Medical Corps, U. S. Army, Chief of Eye, Ear, Nose 

and Throat Service. 
Maj. Max R. Stockton, Medical Corps, U. S. Army, Assistant Chief of Eye, Ear, 

Nose and Throat Service. 
Dr. Leroy S. Townsend, Chief of X-ray Service. 

Maj. Henry W. Grady, Medical Corps, U. S. Army, Chief of Physio-Therapy Service. 
Maj. Clyde W. Jump, Medical Corps, U. S. Army, Obstetrician. 
Maj. Ernest J. Steves, Medical Corps, U. S. Army, Cardiologist. 
Maj. Carlton L. Vanderboget, Medical Corps, U. S. Army. 
Maj. John C. Woodland, Medical Corps, U. S. Army. 
Maj. Francis W. Gustites, Medical Corps, U. S. Army. 
Maj. Walcott Denison, Medical Corps, U. S. Army. 
Maj. George F. Aycock, Medical Corps, U. S. Army. 
Capt. Emery E. Ailing, Medical Corps, U. S. Army. 
Capt. Alvin L. Gorby, Medical Corps, U. S. Army. 
Capt. Walter S. Jensen, Medical Corps, U. S. Army. 
Capt. August W. Spittler, Medical Corps, U. S. Army. 
Capt. William R. Craig, Medical Corps, U. S. Army. 
Capt. Donald C. Snyder, Medical Corps, U. S. Army. 
Capt. Loren D. Moore, Medical Corps, U. S. Army. 
Dr. William P. Christian, Acting Dentist. 

Internes. 

Dr. Elvus J. Allgood Dr. William E. Olson 

Dr. Hymen S. Barahal Dr. John S. Pixley 

Dr. Carl R. Bogardus Dr. John W. Raulston 

Dr. Robert P. Hargreaves Dr. Buell F. Roche 

Dr. John E. Hartsaw Dr. Henry L. Wollenweber 



* Board of Health Laboratory. 

Dr. Lewis B. Bates, Chief of Laboratory. 

Maj. George C. H. Franklin, Medical Corps, U. S. Army, Bacteriologist. 
Maj. Raymond O. Dart, Medical Corps, U. S. Army, Pathologist. 
Mr. James E. Jacob, Chemist. 

Corozal Hospital. 

Maj. Sidney L. Chappell, Medical Corps, U. S. Army, Superintendent. 

Maj. Frank H. Dixon, Medical Corps, U. S. Army. 

Capt. John P. Russell, Medical Corps, U. S. Army. 

Dr. Lawrence G. Combs, Veterinarian and Dairy Manager. 

Colon Hospital. 

Maj. Hertel P. Makel, Medical Corps, U. S. Army, Superintendent. 

Dr. William V. Levy, Chief of Medical Service. 

Dr. Wayne Gilder. 

Maj. Henry M. Van Hook, Medical Corps, U. S. Army. 

Maj. Meredith R. Johnston, Medical Corps, U. S. Army. 

Capt. Eugene W. Billick, Medical Corps, U. S. Army. 

Capt. Leland E. Dashiell, Medical Corps, U. S. Army. 

Capt. Don Longfellow, Medical Corps, U. S. Army. 

Palo Seco Leper Colony. 

Dr. Ezra Hurwitz, Superintendent. 

Gatun Dispensary. 

Dr. James A. Grider, District Physician. 

Pedro Miguel Dispensary. 

Dr. John C. Wilkinson, Acting District Physician. 
Dr. Denver F. Gray. 

Balboa Dispensary. 

Dr. Littleton O. Keen, District Physician. 
Dr. Walter C. Friday. 
Dr. Julian R. Hunt. 
Dr. William H. Presnell. 
Dr. Harry E. Fenton. 

Ancon Dispensary. 

Dr. Walter K. Olson, District Physician. 
Dr. George Eugene. 



10 

DIVISION OF SANITATION. ' 

Panama Health Office. 

Dr. Jesse L. Byrd, Health Officer. 

Mr. James M. Carpprow, Sanitary Inspector. 

Mr. John P. Corrigan, Sanitary Inspector. 

Mr. Morris M. Seeley, Sanitary Inspector. 

Mr. George L. Willett, Sanitary Inspector. 

Mr. Jordan F. Jordan, Sanitary Inspector. 

Dr. Frederick F. Dowd, Veterinarian and Meat Inspector. 

Dr. Troy S. Hopkins, Veterinarian and Meat Inspector. 

Dr. Henry A. Lewis, Vaccinator. 

Cristobal-Colon Health Office. 

Dr. David^G. Sampson, Health Officer. 

Mr. Thomas A. Leathley, Sanitary Inspector. 

Mr. Charles H. Bath, Sanitary Inspector. 

Mr. E. Frederick Quimby, Sanitary Inspector. 

Dr. I. C. Mattatall, Supervising Veterinarian and Meat Inspector. 

Dr. Claire C. Clay, \'eterinarian and Meat Inspector. 

Dr. William F. Gross, Veterinarian and Meat Inspector. 

Canal Zone Sanitation. . 

Mr. Charles L. Pierce, Division Sanitary Inspector, Southern Division, Pedro Miguel, 
Ancon-Balboa, and Panama-Suburban Districts, Ancon. 

Mr. Raymond E. Forbes, Sanitary Inspector, Ancon. 

Mr. Carl G. Brown, Sanitary Inspector, Ancon. 
Mr. Charles A. Roach, Sanitary Inspector, Northern District, Gatun. 

DIVISION OF QUARANTINE. 

Surgeon Marion F. Haralson, U. S. P. H. S., Chief Quarantine Officer (See Chief 
Health Office). 

Cristobal-Colon Qtiaranline, Cristobal. 

Dr. Charles A. Hearne, Quarantine Officer. 
Dr. Francis L. Alexaitis. 
Dr. Herbert L. Phillips. 
Dr. Samuel D. Aj^cock. 

Balboa- Panama Quarantine, Balboa. 

Dr. John D. Odom, Quarantine Officer. 
Dr. Philip Horwitz. 
Dr. Samuel S. Irvin. 
Dr. Boldridge E. Kneece. 



11 



FINANCIAL STATEMENT. 



The funds for the operation of the Health Department are derived 
from specific appropriations made annually by Congress, and from the 
earnings of the Department. 



OPERATING EXPENSES AND EARNINGS OF THE HEALTH DEPARTMENT 
CALENDAR YEAR 1930. 


■ 




Operating 
expenses. 


Earnings. 


Per cent 

self 
support- 
ing. 


Gross cost 

per 

patient 

per day. 


Gorgas Hospital 


• $886,250.66 
= 175,860.52 

3 226,883.20 

38,138.09 

4 88,136.40 

s 66,744.00 

142,100.15 

142,662.64 

89,245.99 

8,336.51 

"46,331.53 


$438,655.63 
104,442.54 

196,469.60 

20,988.75 
30,902.97 

8,143.82 

8 116,203.92 
51,116.49 
28,392.59 


49 
59 

86 

55 
35 

12 

81 
36 
32 


$5.40 


Colon Hospital 


4.27 


Corozal Hospital (for the insane, 

chronics and cripples) 

Palo Seco Leper Colony 

Maritime Quarantine Service 


.88 
1.06 


Sanitation of cites of Panama and 
Colon 




Street cleaning and garbage col- 
lection and disposal, cities of 
Panama and Colon... 




Canal Zone sanitation 




Line dispensaries. .. 




Medical storehouse 




Chief Health Ofifice and miscel- 
laneous 


417.26 


1 








Total 


- 1,910,689.69 


995,733.57 


52 





■ Includes Army pay of Army medical officers on duty at this institution which amounted to 

Also includes cost of operation of Board of Health Laboratory. 

' Includes Army pay of Army medical officers on duty at this institution which amounted to 

Also includes cost of operating Colon Dispensary. 

' Includes Army pay of Army medical officers on duty at this institution which amounted to 

< Includes Public Health Service pay of Public Health Service Officer acting as Chief Quarantine Officer, 

which amounted to 

s Includes Public Health Service pay of Public Health Service Officer acting as Health Officer of Panama 

City part of the year 

' Includes Army pay of Chief Health Officer which amounted to 



' Includes Army and Public Health Service pay, which amounted to 

' Earnings include the 75 per cent of total expense, plus 10 per cent overhead, which is billed against the 
Republic of Panama. 

OPERATING EXPENSES OF THE HEALTH DEPARTMENT, CALENDAR YEAR 1930, 
SHOWING .^MOUNTS CHARGED TO VARIOUS ACCOUNTS. 



ill9,385.38 

23,600.09 

14,508.71 

5,457.00 

3,149.20 
7,200.00 

173,300.38 



Gold payroll (white employees) : 

Panama Canal pay.... $672,555.09 

Army pay..... 164,694.18 

Public Health Service pay.- 8,606.20 

$845,855.47 

Silver payroll (colored employees) 447,924.64 

Subsistence supplies ! 246,464.27 

Ice 6,001.70 

Hospital supplies and drugs 81,937.11 



12 



Equipment _ $16,528.82 

Miscellaneous material and supplies 68,645.45 

Freight on supplies 1,566.82 

Laundry 44,068.01 

Telephones, 15,991.20 

Repatriation of patients physically or mentally disabled.— 8,722.10 

Medical storehouse operation 8,336.5 1 

Launch service 7,005.40 

Electric current 14,029.90 

Electric repairs and installations 10,394.39 

Water 13,838.99 

Motor transportation charges (except for hospitals, quarantine 
stations, and dispensaries which operate their own motor vehi- 
cles) 51,931.75 

Repairs to motor vehicles of hospitals, dispensaries, and quarantine 

stations.... 2,009.51 

Rental of quarters 3,024.29 

Building repairs..:. 2,679.88 

Miscellaneous work by Municipal Engineering Division 4,043.19 

Miscellaneous work by Mechanical Division. 5,912.83 

Miscellaneous charges from other Panama Canal departments 3,777.46 

Total operating expenses 1,910,689.69 

Salaries of Army medical officers, and Public Health Service officers, 

paid from appropriations for those services... 173,300.38 

Total operating expenses as charged against Health De- 
partment funds... 1,737,389.31 



VITAL STATISTICS— POPULATIONS OF THE CANAL ZONE, 
PANAMA CITY, AND COLON. 

The Health Department of The Panama Canal secures, analyzes 
and makes reports on the vital statistics (births, deaths, and disease 
rates) of the three geographical units of the population residing on the 
Isthmus of Panama, namely, the population of the Canal Zone, of the 
city of Panama, and of the city of Colon. 

Properly to interpret these statistics, it is essential that there be some 
understanding of the composition of the various units of the popula- 
tion, their movement, and some of the special local factors involved 
which usually are not encountered in stabilized populations of com-, 
munities in the various parts of the world. 

A census of the population of the Canal Zone is made coincident 
with the decennial census taken throughout the United States. During 
intercensus periods, the police authorities of the Canal Zone make an 
annual census. The population figures for the Canal Zone are therefore 
obtained annually by actual enumeration. 



13 

The Republic of Panama takes a census every ten years, the last 
enumeration having been made in 1930. During intercensus periods, 
the population figures for Panama City and Colon have been corrected 
by the addition or subtraction annually of estimated increases or de- 
creases (arithmetic) based on the increases or decreases occurring 
during the ten-year period between the last two censuses of record. 

The population of the Canal Zone consists of white American em- 
ployees and their families, colored alien employees and their families, 
military and naval garrisons, representatives of shipping companies, 
contractors, church and welfare workers, etc., and colored alien agri- 
culturists who lease land under revocable licenses. 

The term "employees" as used in Health Department reports in- 
cludes employees of The Panama Canal proper and the Panama Rail- 
road Company, which is a corporation owned by the United States 
Government. 

There are about 3,500 white American employees, the usual propor- 
tion of whom have families, most of whom reside in the Canal Zone. 
During the period of construction, the average age of this group as a 
whole was much below the present average, and a larger proportion had 
no dependents residing on the Zone. With the passage of years this 
group has become stabilized and is approaching the age period in which 
diseases of the chronic degenerative type are more common. They 
also are now becoming eligible for retirement through length of service, 
but as residence on the Zone subsequent to retirement is generally not 
permitted, most of them return to the United States. It should there- 
fore be borne in mind that from early construction days to about the 
present time the white American employees have been of a younger 
age group than is normally encountered in stabilized populations and 
that in the future their death rates will be somewhat lower than are or- 
dinarily the case in such communities as practically all who are retired 
on account of disability or on account of eligibility for retirement 
through length of service will cease to be residents of the Canal Zone. 

The Panama Canal employs approximately 12,000 colored persons 
(mostly West Indians), a normal proportion of whom are married and 
have families. Only one-third of these employees actually live in the 
Canal Zone, the remainder residing principally in Panama City and 
Colon. In addition there are about 4,250 colored alien agriculturists 
and their families living on the shores and islands of Gatun Lake, and 
elsewhere in the Canal Zone. This population is made up principally 
of West Indians who formerly were employees (construction period) 



14 

and they eke out an existence by the cultivation of bananas, yams, 
corn, etc. They Hve in areas in which no malaria control measures 
are carried out, and the medical attention given them, which is hap- 
hazard, is at the expense of the Health Department. 

West Indians comprised the bulk of the laborers engaged in con- 
struction of the Canal. During the construction period they were of 
a younger average age than is normally encountered in stabilized popu- 
lations of the same race, but during recent years as the result of advanc- 
ing age and the fact that most of them remain on the Zone until death, 
this group has become more stabilized and is now more nearly compar- 
able with stabilized populations elsewhere. 

The Army maintains garrisons on the Zone which now aggregate 
about 9,000 military personnel. The enlisted personnel, about 8,700 
individuals, is a physically selected, unmarried group, most of whom 
are between 20 and 30 years of age. The Navy also maintains a garri- 
son of approximately 1,000 enlisted personnel. The presence of these 
men in the population tends to reduce both general death rates (large 
military group of physically selected young men) and birth rates (ab- 
normally large unmarried group) for the population of the Canal Zone 
as a whole. 

The population of the city of Panama has increased rapidly during 
the past 25 years (1905, 21,984; 1914, 54,000; 1924, 65,500; 1930, 
74,402). Formerly communication with the provincial districts of the 
Republic was principally by coastwise steamers or sailboats. During 
recent years there has been great improvement in transportation facili- 
ties by land through the development of ambitious road building 
projects. The plans of the Panamanian Government provide for the 
establishment of hospitals and clinics in provincial districts and this 
is now being done. Up to the present time the Government hospital 
in Panama City (Santo Tomas) has been the only general hospital 
maintained by the Republic in which its citizens could obtain special- 
ized treatment. The consequence is that with the development of 
roads into the provinces it has become more and more the custom to 
bring patients therefrom and from villages adjacent to Panama City, 
to Santo Tomas Hospital for treatment. It not infrequently occurs 
that patients from the provinces who are admitted to Santo Tomas 
Hospital give a Panama City address as their residence. Notwith- 
standing that efforts are made to correct these errors in compiling 
statistics, an appreciable number of deaths are charged to Panama City 
that are in reality chargeable to the provinces. The persistently 
higher death rates that are of record for Panama City as compared 



15 



with Colon appear to be attributable to this factor. The town of 
Colon is somewhat isolated and the transient and constantly shifting 
population is of minor consideration as compared with Panama City. 
Bearing in mind the various unusual factors that must be given con- 
sideration in the interpretation of vital statistics for elements of popu- 
lation involved on the Isthmus, the following statistical data are 
presented : 

GENERAL DEATH RATES, ALL CAUSES, AND FROM 
DISEASE ONLY. 

Population Canal Zone. — Death rates from all causes are available 
since the beginning of construction (1905) and those for disease only 
are readily available since 1913. These data are incorporated and 
shown graphically in Tables 1 and 2: 

Table 1. — Deaths From All Causes, Canal Zone Population (Employees 

AND NoNEMPLOYEES). 

Absolute numbers and rates per 1,000 of population. 







Deaths 


Rate 


Year. 


Popula- 


from all 


per 




tion. 


causes. 


1,000. 


1905 


23,463 


828 


35.29 


1906 


34,095 


1,700 


49.86 


1907 


54,036 


1,708 


31.60 


1908 


67,146 


1,273 


18.95 


1909 


76,900 


1,025 


13.33 


1910 


86,465 


1,251 


14.47 


1911 


90.434 


1,385 


15.32 


1912 


79,279 


1,129 


14.24 


1913 


61,700 


1,047 


16.97 


1914 


46,379 


710 


15.31 


1915 


31,496 


410 


12.83 


1916 


31,447 


343 


10.91 


1917 


33,044 


328 


9.93 


1918 


33,803 


286 


8.49 


1919 


32,366 


247 


7.63 


1920 


27,459 


242 


8.81 


1921 


31,377 


236 


7.52 


1922 


31,098 


254 


8.17 


1923 


31,793 


253 


7.96 


1924 


33,723 


305 


9.05 


1925 


34,840 


297 


8.53 


1926 


36,480 


284 


7.79 


1927 


36,794 


298 


8.10 


1928 


37,056 


316 


8.53 


1929 


38,825 


298 


7.67 


1930 


39,467 


282 


7.14 




16 



Table 2. — Deaths From Disease Only, Canal Zone Population (Employees 

and nonemployees). 

Absolute numbers and rates per 1,000 of population. 





„ , 1 Deaths 


Rate 




Year. 


Popula- 


from dis- 


per 






tion. 


ease only. 


1.000. 




1913 


61,700 


890 


14.43 




1914 


46,379 


614 


13.24 




1915 


31,496 


361 


11.30 


■■^■^^ 


1916 


31,447 


290 


9.22 


■i^l^H 


1917 


33,044 


273 


8.26 


^^■H 


1918 


33,803 


216 


6.36 


^■■H 


1919 


32,366 


207 


8.40 




1920 


27,459 


211 


7.68 




1921 


31,377 


211 


6.72 


^^^ 


1922 


31,098 


220 


7.08 


■■■■ 


1923 


31,793 


227 


7.14 


■■■i 


1924 


33,723 


270 


8.01 


^■^^H 


1925 


34,840 


241 


6.92 


■■■ 


1926 


36,480 


245 


6.72 


■■■ 


1927 


36,794 


265 


7.20 


■IH^ 


1928 


37,056 


273 


7.37 


■^^ 


1929 


38,825 


263 


6.77 


■I^H 


1930 


39,467 


242 


6.13 


■■■ 



There has been gradual reduction in total death rates as well as death' 
rates from disease. The rate of reduction can best be determined by 
comparing rates during the latter part of the construction period with 
those prevailing during recent years. 

These comparisons by five-year periods are as follows: 





1911-1915. 


1916-1920. 


1921-1925. 


1926-1930. 


Total death rates per 1,000 of population 


14.97 
■13.37 


9.14 
7 56 


8.24 
7 1Q 


7.85 
6 84 








■ 1913-1915. 











The progress being made in health conservation is best measured 
by comparing the death rates for disease only. As has been explained 
heretofore, the new factor now affecting this group of the population 
is the advancing age of the employees, more particularly the colored 
element. With the advancing age and greater prevalence of chronic 
degenerative diseases in this group it is doubtful if further material 
reduction in death rates can be attained. It is worthy of note that the 
death rates (total and for disease only) for 1930 were the lowest ever 
observed in the population of the Canal Zone. 

Panama City. — Total death rates and those for disease only are in- 
corporated and presented graphically in Tables 3 and 4: 



17 



T.\BLE 3 — Deaths From All Causes, City of Panama. 
Absolute numbers and rates per 1,000 of population. 







Deaths 


Rate 




Year. 


Popula- 


from all 


per 






tion. 


causes. 


1,000. 




1905 


21,984 
25,518 
33,548 
37,073 
40,801 
45,591 
46,555 
47,057 
47,172 
53,948 
60,373 
60,778 
61,074 
61,369 


1,447 
1,142 
1,156 
1,292 
1,038 
1,446 
1,456 
1,380 
1,507 
1,863 
1,810 
1,765 
1,714 
1,314 


65.82 
44.75 
34.45 
34.83 
25.44 
31.72 
31.27 
29.33 
31.95 
34.53 
29,98 
29.04 
28.06 
21.41 




1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 






















1919 


61,369 


1,211 


19.74 




1920 


59,458 


1,297 


21.81 




1921 


61,000 


1,336 


21.90 




1922 


62,500 


1,279 


20.46 




1923 


64,000 


1,106 


17.28 


■■^IHHH 


1924 


65,500 


1,168 


17.83 


^^^■I^^B 


1925 


67,000 


1,169 


17.45 


■■■■■i 


1926 


68,500 


1,188 


17.34 


■■■^■IHi 


1927 


70 , 000 


1,248 


17.83 


^■^■■■i 


1928 


71,500 


1,434 


20.06 




1929 


73,000 


1,413 


19.36 


■■■■■■■ 


1930 


74,402 


1,307 


17.57 


■^^^■1 



Table 4. — Deaths From Disease Only, City of Panama. 
Absolute numbers and rates per 1,000 of population. 



„ , Deaths 

Popula- from dis- 
tion. ea,se only. 



47,172 
53,948 
60,373 
60,778 
61,074 
61,369 
61.369 
59,458 
61,000 
62,500 
64,000 
65 , 500 
67,000 
68 , 500 
70,000 
71,500 
73,000 
74,402 



Rate 

per 

1,000. 



30.21 
32.85 
28.97 
28.00 
27.20 
20.92 
18.98 
20.96 
21.08 
19.86 
16.84 
17.22 
16,81 
16.82 
17.16 
19.44 
18.77 
16.81 



MR 26916- 



18 



Examination of these tables indicates that the rates have gradually 
decreased. The trend downward, particularly for disease only, can 
best be appreciated by considering the rates by five-year periods: 

1911-1915. 1916-1920.' 1921-1925. 1926-1930. 



Total death rates per 1,000 of population 

Death rates from disease per 1,000 of population. 



31.42 
30 63 



24.01 
23.22 



18.94 
18.31 



18.44 
17.81 



■Average for three-year period (1913-1915). 

The total death rates per 1,000 of population for the city of Manila, 
P. I., for 1928 was 23.06 and for New Orleans, La., 18.7. These two 
cities are much larger than the city of Panama, but climatic conditions 
and composition of the population are somewhat similar. 



City of Colon. — The general death rates and those from disease only 
are presented and shown graphically in Tables 5 and 6: 

Table 5. — Deaths From All Causes, City of Colon. 
Absolute numbers and rates per 1,000 of population. 







Deaths 


Rate 


Year. 


Popula- 


from all 


per 




tion. 


causes. 


1,000. 


1905 


11,176 


553 


49.48 


1906 


13,651 


703 


51.50 


1907 


14,549 


571 


39.25 


1908 


15,878 


418 


26.32 


1909 


17,479 


396 


22.65 


1910 


19,535 


514 


26.31 


1911 


19,947 


527 


26.42 


1912 


20,174 


493 


24.44 


1913 


20,232 


489 


24.17 


1914 


23,265 


590 


25.36 


1915 


29,331 


640 


21.82 


1916 


24,693 


696 


28.19 


1917 


25,386 


667 


26.27 


1918 


26,078 


616 


23.62 


1919 


26,078 


573 


21.97 


1920 


31,203 


554 


17.75 


1921 


31,050 


497 


16.01 


1922 


30,900 


445 


14.40 


1923 


30,750 


393 


12.78 


1924 


30,600 


475 


15.52 


1925 


30,450 


401 


13.17 


1926 


30,300 


452 


14.92 


1927 


30,150 


423 


14.03 


1928 


30,000 


442 


14.73 


1929 


29,850 


492 


16.48 


1930 


29,765 


518 


17.40 




19 

Table 6. — Deaths From Disease Only, City of Colon. 
Absolute numbers and rates per 1,000 of population. 

Year. 



1913 
1914 
1915 
1916 
1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 
1925 
1926 
1927 
1928 
1929 
1930 





Deaths 


Rate 


Popula- 


from dis- 


per 


tion. 


ease only. 


1,000. 


20,232 


460 


22.74 


23 , 265 


563 


24.20 


29,331 


604 


20.59 


24,693 


662 


26.81 


25,386 


642 


25.29 


26,078 


587 


22.51 


26,078 


536 


20.55 


31,203 


517 


16.57 


31,050 


468 


15.07 


30,900 


421 


13.62 


30,750 


377 


12.26 


30,600 


455 


14.87 


30,450 


379 


12.45 


30,300 


427 


14.09 


30,150 


404 


13.40 


30,000 


426 


14.20 


29,850 


467 


15.64 


29,765 


490 


16.46 




The records indicate a downward trend in both rates until about 
1924, since which time there has been a tendency to increase. The 
general trend can best be shown by comparing the average rates for 
five-year periods : 



1911-1915, 



1916-1920. 1921-1925. 



Total death rates, per 1,000 of population. ...... 

Death rates from disease per 1,000 of population . 



24.26 
22.33 



23.27 
22.07 



14.37 
13.66 



15.49 
14.76 



The trends for general death rates and death rates for disease only 
were downward between 1911 and 1921, since which time there has 
been an increase. The increase during recent years is probably a seem- 
ing rather than an actual one. The recorded population figures of 
Colon for 1930 show an actual decrease in population since 1921. It 
has been suggested that enumeration of the population was not 
complete during the last census (1930) and that as a matter of fact 
there has been slight but continuous increase in population since 1921. 

BIRTH RATES, CANAL ZONE, PANAMA CITY, AND COLON. 



In analyzing birth rates it is important for many reasons to have 
knowledge not only of the total rate for the new born, but to know 
also the rate of those born alive and of the stillborn. The data 
necessary for such tabulation are available since 1915. 



20 



Rates for the Canal Zone are incorporated in Table 7 : 

Table 7— BIRTHS, CANAL ZONE POPULATION (EMPLOYEES AND NONEMPLOYEES). 

ABSOLUTB NUMBERS AND RATES PER 1,000 OF POPULATION. 



Year. 


Population. 


Births. 
(Absolute numbers.) 


Rate per 1,000 population. 


Total. 


Alive. 


StiU- 
born. 


Total. 


Alive. 


StiU- 
born. 


1916 


31,447 
33,044 
33,803 
32,366 
27,459 
31,377 
31,098 
31,793 
33,723 
34,840 
36.480 
36,794 
37,056 
38,825 
39,467 


673 
712 
770 
732 
667 
807 
722 
623 
730 
651 
669 
579 
550 
538 
524 


640 
669 
725 
695 
631 
776 
691 
591 
694 
616 
635 
547 
513 
508 
492 


33 
43 
45 
37 
36 
31 
31 
32 
36 
35 
34 
32 
37 
30 
32 


21.40 
21.55 
22.78 
22.62 
24.29 
25.72 
23.22 
19.60 
21.65 
18.68 
18.34 
15.74 
14.84 
13.85 
13.28 


20.35 
20.25 
21.45 
21.47 
22.98 
24.73 
22.22 
18.59 
20.58 
17.68 
17.41 
14.87 
13.84 
13.08 
12.47 


1 05 


1917 


1 30 


1918 


1 33 


1919 


1 14 


1920 


1 31 


1921 


99 


1922 

1923 


1.00 
1 01 


1924 


1.07 


1925 


1 00 


1926 


.93 


1927 


87 


1928 

1929 


1.00 

.77 


1930 


81 







A cursory examination of this table discloses the fact that there has 
been a striking decrease in birth rates in the Canal Zone since 1915. 
The rate of decrease can best be appreciated by comparing the average 
rates by five-year periods: 



1916-1920. 



1921-1925. 



1926-1930. 



Total birth rate per 1,000 population 
Live birth rate per 1,000 population. 
Stillbirth rate per 1,000 population . . 



22.48 

21,25 

1.23 



21.70 

20.69 

1.01 



15.16 
14.29 

.87 



The marked decrease in total birth rates during recent years is 
attributable in large measure to the following factors : Advancing age 
of the initial employees; sufficient time not elapsed for those born in 
earlier years to attain maturity and marry; and large unmarried group 
of military population. 

That progress is being made in maternity welfare activities is 
evidenced by the fact that the rate for the stillborn is gradually decreas- 
ing: 1916-1920, 1.23; 1926-1930, 0.87. 

The population of the Canal Zone is made up of two quite distinct 
elements, (a) white American employees and Army and Navy officers 
and their families, and Army and Navy enlisted personnel, and (b) 
colored alien employees and agriculturists and their families, and it is 
possible to examine more in detail the birth rates for these two elements 
of the population. It should be remembered, however, that the large 
number of unmarried enlisted personnel of the Army and Navy 
(approximately 9,700 during 1930) causes an abnormally low birth 
rate among the white population. The rates for the two groups are 
incorporated in Tables 8 and 9: 



21 



Tablb 8— births, canal ZONE— WHITE ONLY. 





White 
populatioD. 


Births, absolute numbers. 


Rate per 1,000 population. 


Year. 


Total. 


Born 
alive. 


Still- 
born. 


Total. 


Born 
alive. 


Still- 
born. 


1916 


15,063 
18,108 
18,220 
14,694 
14,224 
16,442 
14,083 
15,483 
16,187 
15,817 
17,036 
16,521 
16,712 
16,967 
16,511 


186 
237 
266 
250 
239 
311 
247 
212 
267 
201 
230 
173 
178 
181 
159 


172 
225 
255 
242 
231 
301 
242 
206 
255 
193 
222 
169 
170 
176 
154 


14 

12 

11 
8 
8 

10 
5 
6 

12 
8 
8 
4 
8 
5 
5 


12.35 
13.09 
14.60 
17.01 
16.80 
18.91 
17.54 
13.69 
16.49 
12.71 
13.50 
10.47 
10.65 
10.66 
9.63 


11.42 
12.43 
14.00 
16.47 
16.24 
18.30 
17.18 
13.30 
15.75 
12.20 
13.03 
10.23 
10.17 
10.37 
9.33 


.93 


1917 


.66 


1918: 


60 


1919 

1920 

1921 

1922 

1923 


.54 
.56 
.61 
.36 
.39 


1924 


.74 


1925 

1926 


.51 

.47 


1927 


.24 


1928 


.48 


1929 

1930 


.29 
.30 



Table 9.— BIRTHS, CANAL ZONE— COLORED ONLY. 





Colored 
population. 


Births, absolute numbers. 


Rate per 1,000 population 


Year. 


Total. 


Born 
alive. 


Still- 
born. 


Total. 


Born 
alive. 


Still- 
born. 


1916 


16,384 
14,936 
15,583 
17,672 
13,235 
14,935 
17,015 
16,310 
17,536 
19,023 
19,444 
20,273 
20,344 
21,858 
22,956 


487 
475 
504 
482 
428 
496 
475 
411 
463 
450 
439 
406 
372 
357 
365 


468 
444 
470 
453 
400 
475 
449 
385 
439 
423 
413 
378 
343 
332 
338 


19 
31 
34 
29 
28 
21 
26 
26 
24 
27 
26 
28 
29 
25 
27 


29.72 
31.80 
32.34 
27.27 
32.34 
33.21 
27.92 
25.20 
26.40 
23.66 
22.58 
20.03 
18.29 
16.33 
15.90 


28.56 
29.73 
30.16 
25.63 
30.22 
31.80 
26.39 
23.61 
25.03 
22.24 
21.24 
18.65 
16.86 
15.19 
14.72 


1.16 


1917 


2.07 


1918 


2.18 


1919 


1.64 


1920. 


2.12 


1921 


1.41 


1922 


1 53 


1928 


1.59 


1924 


1.37 


1925 


1.42 


1926 

1927 


1.34 
1.38 


1928 


1.43 


1929 


1.14 


1930 


1.18 



It will be noted that since 1916 Canal Zone birth rates have gradually 
declined in both groups. The rate of decline has been much greater 
in the colored population than in the white Americans. The low birth 
rate in white population as compared with the colored is attributable 
in part to the inclusion in the white population of the large group of 
unmarried military and naval personnel (9,700). The rate of decline 
in both groups can best be appreciated by comparing average rates by 
five-year periods: 





1916-1920. 


1921-1925. 


1926-1930. 




White. 


Colored. 


White. 


Colored. 


White. 


Colored. 


Total birth rate per 1,000 of population 

Live birth rate per 1,000 of population 

Stillbirth rate per 1,000 of population 


14.66 

14.00 

.66 


30.54 

28.72 

1.81 


15.87 

15.34 

.53 


27.06 

25.60 

1.46 


11.00 

10.64 

.36 


18.49 

17 20 

1.29 



Panama City. 
in Table 10: 



-The birth rates for Panama City are incorporated 



22 



Table 10— BIRTHS, PANAMA CITY. 

ABSOLUTE NUMBERS AND RATES PER 1,000 OF POPULATION. 



Year. 


Population. 


Births, absolute numbers. 


Rate per 1,000 population. 


Total. 


Born. 
alive. 


StiU- 
born. 


Total. 


Born, 
alive. 


StiU- 
born. 


1916 


60,778 
61,074 
61,369 
61,369 
59,458 
61,000 
62,500 
64,000 
65,500 
67,000 
68,500 
70,000 
71,500 
73,000 
74.402 


2,598 
2,772 
2,472 
2,359 
2,532 
2,311 
2,162 
2,163 
2,271 
2,339 
2,117 
2,509 
2,578 
2,517 
2,760 


2,371 
2,578 
2,308 
2,214 
2,376 
2,173 
2,058 
2,043 
2,144 
2,220 
2,003 
2,389 
2,458 
2,392 
2,626 


227 
194 
164 
145 
156 
138 
104 
120 
127 
119 
114 
120 
120 
125 
134 


42.75 
45.39 
40 28 
38 44 
42.58 
37.89 
34.59 
33.80 
34.67 
34.91 
30 91 
35.84 
36.06 
34.48 
37.09 


39.01 
42.21 
37.61 
36.08 
39 96 
35.62 
32.93 
31.92 
32.73 
33.13 
29.24 
34.13 
34.38 
32.77 
35.29 


3 73 


1917 


3 18 


1918 


2 67 


1919 .... 


2 36 


1920 


2 62 


1921 


2 26 


1922 


1 66 


1923 

1924 

1925 

1926 

1927 


1.88 
1.94 
1.78 
1.67 
1.71 


1928 

1929 

1930 


1.68 
1.71 
1.80 



The total rates for Panama City have been fairly stationary for the 
past 15 years, with a slight tendency to decrease. Increasingly larger 
numbers of prospective mothers are now admitted to hospital for con- 
finement and it is estimated that at the present time, of all births in 
Panama City, about 50 per cent are born in Santo Tomas Hospital. 
The midwives, during recent years, have been more closely supervised,, 
and during the past year their work has been under the constant super- 
vision of a visiting nurse. That these measures are beginning to show 
results is evidenced by the downward trend in the stillbirth rates. 
The trend of total birth rates, live birth rates, and stillbirth rates is 
shown in the following averages of rates by 5-year periods for the past 
15 years: 



1916-1920. 1921-1925. 1926-1930. 



Total birth rate per 1,000 population. 
Live birth rate per 1,000 population. . 
Stillbirth rate per 1,000 population. . . 



41.88 

38.96 

2.91 



35.14 

33.25 

1.90 



34.92 

33.20 

1.72 



Colon. — The data concerning birth and birth rates for the city of 
Colon are incorporated in Table 1 1 : 



Table 11.— BIRTHS, COLON. 

ABSOLUTE NUMBERS AND RATES PER 1,000 OF POPULATION. 



Year. 



1916 
1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 
1925 
1926 
1927 
1928 
1929 
1930 



Population. 



24,693 
25,386 
26,078 
26,078 
31,203 
31,050 
30,900 
30,750 
30,600 
30,450 
30,300 
30, 150 
30,000 
29,850 
29,765 



Births, absolute numbers. 



Total. 



814 
958 
861 
964 
1,014 
969 
810 
748 
726 
800 
755 
795 
801 
866 
912 



Born, 
alive. 



757 
891 
795 
908 
962 
919 
759 
709 
690 
769 
712 
737 
760 
822 
877 



Still- 
born. 



Rate per 1,000 population. 



Total. 



32.96 
35.77 
33.02 
36.97 
32.50 
31.21 
26.21 
24.33 
23.73 
26.27 
24.92 
26.37 
26.70 
29.01 
30.64 



Born, 
alive. 



30.66 
33.25 
30.49 
34.82 
30.83 
29.60 
24.56 
23.06 
22.55 
25.25 
23.50 
24.44 
25.33 
27.54' 
29.46 



Still- 
born. 



2 31- 

2 52 

2.53 

2.15 

1.67 

1.61 

1.65 

1.27 

1.18 

1.02 

1.42 

1.92 

1.37 

1.48 

1.18 



23 



The general trend in birth rates for Colon since 1916 has been a 
declining one though not so noticeable as for Panama City. Consider- 
ing the rate by 5-year periods, for the past 15 years, the averages for 
each period are as follows: 



1916-1920. 



1921-1925. 



1926-1930. 



Total birth rate per 1,000 population 
Live birth rate per 1,000 popuhtion . 
Stillbirth rate per 1,000 population . . 



34.54 

32.32 

2.22 



26.36 

25.01 

1.35 



27.51 

26.05 

1.47 



The increase in birth rates for the past 5 years is probably a 
seeming rather than actual one and due in all probability to error in 
population figures. 



INFANT MORTALITY RATES, CANAL ZONE, PANAMA CITY, 

AND COLON. 

Records of infant mortality for the three groups of population con- 
cerned, Canal Zone, Panama City, and Colon, have been compiled 
since 1916 and the data are presented in Table 12: 

Table 12.— INFANT MORTALITY, CANAL ZONE, PANAMA CITY, AND COLON. 

ABSOLUTE ^^JMBERS AND RATES PER 1,000 OP LIVE BIRTHS. 



Canal Zone. 


Panama. 


Colon. 




Live births. 
Absolute 
numbers. 


Deaths. 


Live 
births. 


Deaths. 


Live 
births. 




Year. 


American 
(white). 


Foreign 
(colored). 


Total. 


Deaths. 




a . 

Ms 

a 






il 


c> 
§ 

a. 

1 


"o S 


C5 

s 

□. 


a, £ 

o a 


1-4 

o. 


Il 

o a 


•S.S 


g 
o 

1. 

s 


ll 




la 

PS 


1916 


172 
225 
255 
242 
231 
301 
242 
206 
255 
193 
222 
169 
170 
176 
154 


468 
444 
470 
453 
400 
475 
449 
385 
439 
423 
413 
378 
343 
332 
338 


640 
669 
725 
695 
631 
776 
691 
591 
694 
616 
635 
547 
513 
508 
492 


7 
4 
5 
9 
8 

10 

10 
9 

12 
7 

13 
5 

16 
8 
8 


42 
18 
20 
37 
34 
33 
41 
44 
47 
36 
59 
30 
94 
45 
52 


70 
80 
55 
70 
52 
65 
54 
34 
55 
41 
44 
54 
43 
40 
32 


149 
180 
117 
156 
130 
137 
120 

88 
125 

97 
107 
143 
125 
120 

95 


77 
84 
60 
79 
60 
75 
64 
43 
67 
48 
57 
59 
59 
48 
40 


120 
126 
83 
114 
95 
97 
93 
73 
97 
78 
90 
108 
115 
94 
81 


2,371 
2.578 
2,308 
2,214 
2,376 
2,173 
2,058 
2,043 
2,144 
2,220 
2,003 
2,389 
2,458 
2,392 
2,626 


616 
668 
414 
342 
369 
378 
303 
290 
296 
260 
289 
287 
364 
339 
319 


260 
259 
180 
154 
155 
174 
147 
142 
138 
117 
144 
120 
148 
142 
121 


757 
891 
795 
908 
962 
919 
759 
709 
690 
769 
712 
737 
760 
822 
877 


185 
222 
156 
141 
137 
128 
106 
82 
79 
90 
92 
80 
79 
95 
95 


244 


1917 


249 


1918 


197 


1919 


155 


1920 


142 


1921 


139 


1922 


140 


1923 


116 


1924 


115 


1925.. 


117 


1926 


129 


1927 


109 


1928 

1929 

1930 


104 
116 
108 



To better visualize any results being obtained in the reduction of 
infant mortality rates in the three groups of the population concerned, 
the average rates for each group for the 5-year periods 1916-1920, 
1921-1925, and 1926-1930, are incorporated in the following table: 



24 



INFANT MORTALITY RATES FOR 5-YEAR PERIODS, CANAL ZONE AND CITIES OF 
PANAMA AND COLON. 



Period. 


Canal Zone. 


Panama. 






White. 


Colored. 


Total. 




1916-1920 


29.33 
40 10 
56 12 


146.31 
92.58 
118.07 


107.14 
73,93 
97.59 


203.34 
143.54 
134.65 


194 99 


1921-1925 

192&-1930 


126.10 
112.85 



Canal Zone. — Infant mortality rates in the white American popula- 
tion of the Canal Zone have been quite satisfactory, ranging between 
18 and 59 per 1,000 live births for the years 1916 to 1930 inclusive, 
except for 1928 when they were 94. 

For the colored population the variation during the same period has 
been between 88 and 180. The infant mortality rates in this group 
were considerably in excess of 100 (107 to 143) during the years 1926 
to 1929 inclusive, and for 1930 they still were 95. Efforts are being 
made to lower these rates through a visiting nurse service. 

Panama C^/3'.— Considerable progress has been made since 1916 in 
reducing infant mortality rates in Panama City. The rates for the 
5-year period 1916-1920 average 203 per 1,000 live births, whereas for 
the period 1926-1930 they had been reduced to 135. 

Colon. — Excellent progress has been made in reducing the infant 
mortality rates in Colon. For the 5-year period 1916-1920 the rate 
averaged 195, whereas for the period 1926-1930 it had been reduced 
to 113. 

PRINCIPAL CAUSES OF DEATH, CANAL ZONE. 
PANAMA CITY, AND COLON. 



It has been customary in the Health Department annual reports of 
recent years to report the six principal causes of death from disease 
in Panama Canal employees and in the populations of the cities of 
Panama and Colon. Comparable data for the entire population of 
the Canal Zone have not been reported. The statistics for the past 
five years for the three population groups involved. Canal Zone, 
Panama City, and Colon, are being included in this report. Compar- 
able rates for Panama Canal employees are included in a subsequent 
section. 

Principal causes of death, Canal Zone population. — ^The data on this 
subject are incorporated in Table 13: 



25 



Table 13.— ^X PRINCIPAL CAUSES OF DEATH FROM DISEASE, CANAL ZONE POPULATION, 1926-1930. 

ABSOLUTE NUMBERS AND RATES PER 1,000. 



Population . 



Disease. 



1926. 



Num- 
ber. 



Rate 
per 
1,000. 



1927. 



36,794. 



.. I Rate 
Num- per 
be'"- 1,000. 



Num- 
ber. 



Rate 

per 

1,000. 



1929. 



38,825. 



Num- 
ber. 



Rate 

per 

1,000. 



Num- 
ber. 



Rate 

per 

1,000. 



Tuberculosis (various organs) . . . 

Syphilis 

Nephritis (acute and chronic) . . . 

Diarrhea and enteritis 

Cancer (various organs) 

Pneumonia (broncho and lobar) . 
Organic diseases of the heart . . . . 



.658 
.493 
.411 
.274 
.329 
.247 



.489 
.489 
.435 



.674 
.297 
.513 



.876 
.283 
.592 



.353 
.652 
.462 



.432 
.972 
.297 



.412 
.695 
.386 



.507 
.253 
.532 



.405 

.785 
.557 



Tuberculosis and pneumonia take the greatest toll of life in the 
population of the Canal Zone; diseases of the chronic degenerative 
type such as nephritis, cancer, and organic disease of the heart are being 
noted with greater frequency as the principal cause of death. Special 
studies are being made of the tuberculosis and pneumonia problems. 
These diseases occur with greater frequency in the colored population. 

Principal causes of death, Panama City. — The six principal causes of 
death in the population of Panama City for the past five years are 
shown in Table 14: 

Table 14.— SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, PANAMA CITY 1926-1930. 

ABSOLUTE NUMBERS AND RATES PER 1,000. 



Population . 



Diseaae. 



1926. 



68,500. 



Num- 
ber. 



Rate 

per 

1,000. 



1927. 



70,000. 



Num- 
ber. 



Rate 

per 

1,000. 



1928. 



71,500. 



Num- 
ber. 



Rate 
per 
1,000. 



1929. 



73,000. 



Num- 
ber. 



Rate 

per 

1,000. 



1930. 



74,402. 



Num- 
ber. 



Rate 
per 
1,000. 



Pneumonia (broncho and lobar) 

Tuberculosis (various organs) 

Diarrhea and enteritis including colitis . 

Organic diseases of the heart 

Nephritis (acute and chronic) 

Cancer (various organs) 

Syphilis 



193 
202 
128 

71 
121 

52 



2.82 
2.95 
1.87 
1.04 
1.77 
.76 



187 
180 
122 
112 
105 
56 



2.67 
2.57 
1.74 
1.60 
1.50 
.80 



248 
227 
117 
105 
115 



3.47 
3.17 
1.64 
1.47 
1.61 



231 
204 
148 
118 
114 
67 



3.16 
2.79 
2.03 
1.62 
1.56 
.92 



180 
208 



113 



48 



.67 



2.42 
2.80 
1.32 
1.32 
1.52 
.79 



As is the case with the population of the Canal Zone, tuberculosis 
and the pneumonias are the leading causes of death in Panama City. 
Death rates from these two diseases are much higher in Panama City 
than in the population of the Canal Zone. The death rates from tuber- 
culosis in the Canal Zone ranged between 0.49 and 0.88 per 1,000 popu- 
lation for the years 1926-1930, whereas comparable rates in Panama 
City ranged between 2.57 and 3.17. The differences in rates are 
attributable in large measure to housing conditions in Panama City 
and the economic status of the populations affected. 

A similar disparity will be noted between death rates from the pneu- 
monias in Panama City and the Canal Zone. The very high rates in 



26 



Panama City as compared with the Canal Zone are attributable to 
the factors cited in the case of deaths from tuberculosis. 

Principal causes of death, Colon. — The six principal causes of death 
in the population of Colon, for the period 1926-1930 are shown in 
Table 15: 

Table 15— SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, COLON, 1926-1930. 

ABSOLUTE NUMBERS AND RATES PER 1,000. 



Population . 



Diseases. 



1926. 



30,300. 



Num- 
ber. 



Rate 
per 
1,000. 



1927. 



30,150. 



Num- 
ber. 



Rate 

per 

1,000. 



1928. 



Num- 
ber. 



Rate 

per 

1,000. 



1929. 



Num- 
ber. 



Rate 

per 

1,000. 



1930. 



29,765. 



Num- 
ber. 



Rate 

per 

1.000. 



Pneumonia (broncho and lobar) 

Tuberculosis (various organs) 

Diarrhea and enteritis including colitis . 

Organic diseases of the heart 

Nephritis (acute and chronic) 

Cancer (various organs) 

Apoplexy 

Syphilis 



1.62 
2.54 



.59 
1.25 



1.29 

2.65 

.90 

.73 

1.23 



2.27 

2.10 

.90 



2.11 
2.14 
1.04 
.94 
1.01 



1.65 
2.39 
1.14 
1.08 
1.38 



.94 



26 



.87 



It will be noted as was the case in the other groups of the population 
of the Isthmus, that the leading causes of death are tuberculosis and, 
the pneumonias. 

The most interesting point to be noted is that the death rates from 
both tuberculosis and the pneumonias are very materially lower in 
Colon than in Panama City. The average rates per 1,000 population 
per annum for the 5-year period 1926-1930 are as follows: 



1926-1930. 


Panama City. 


Colon. 




2.91 
2.85 


1.78 




2.36 







The factors probably responsible for this discrepancy are not known 
and the matter is being studied. On the average, housing conditions 
in Colon are better than in Panama City. The rates for Panama City 
are artificially high due to the fact, as explained elsewhere in this report, 
that the principal Panamanian Government hospital (Santo Tomas) is 
located in Panama City and patients treated in that hospital who 
actually reside in the provincial districts not infrequently give a 
Panama City address as their place of residence. 



ACUTE TRANSMISSIBLE DISEASES REPORTED IN 1930. 

Beginning with the annual report of 1929, a table was introduced 
showing the number of cases of transmissible diseases reported to the 
Health Department of The Panama Canal. The reports for the Canal 



27 



Zone are quite complete. For Panama City and Colon, the reports 
are not so complete, especially for the less serious diseases such as 
whooping cough, mumps, etc. The cases reported during 1930 are 
incorporated in Table 16: 

Table 16.-C0NTAGI0US AND INFECTIOUS DISEASES. 

CASES AND DEATHS REPORTED TO THE CHIEF HEALTH OFFICER DURING THE TEAR 1930. 











Presumed place of infection. 








Disease. 


Panama. 


Colon. 


Canal Zone. 


Outside the 

Zone and 

terminal cities. 


Total. 


i 


Q 


1 


Q 


1 




1 


J3 


i 


1 
Q 




206 
131 

29 

2 

309 

122 

2 

10 

(^) 

1 


r 

2 

3 

2 
2 

"'l78' 

1 


105 

43 

5 

3 

107 

49 

4 

2 

{') 
1 


1 

r 

2 

2' 

"■'49' 


71 

14 

2 

' 145 

1,218 

100 

4 

6 

(') 


r 

4 

3 

■■■30' 


17 

18 

26 

4 

535 

20 

1 

3 

(0 


5' 

1 
27 

■■"27' 


399 

206 
62 

154 
2,169 

291 
11 
21 

Cil 

■ 2 

^ 1 

3 


1 




1 




8 


Dysentery, bacillary (unci.) . . 


4 
34 




2 


Meningitis, meningococcus . . . 


7 




284 




1 






1 
















2 




























5 


206 


7 


72 
2 


4 


26 

1 


(^) 

11 

2 


24 
2 
1 


(^) 

27 

2 

125 

1 


322 




5 




1 




3 




42 


1 


80 




1 






1 






Maritime Quarantinable 
diseases. 


















1 


1 


2 


1 


1 


1 


3 


3 


7 


6 















































































' The large number of cases of bacillary dysentery were due to mass infection in a large body of troops in a 
temporary camp. 

' E.xperimental case. 

5 As many cases of penumonia and tuberculosis are not reported until death occurs, this report shows only the 
number of deaths from these two diseases. 

This table gives one a definite conception of the types of trans- 
missible diseases that are most commonly encountered in this region 
and the fatality rates. In general terms the data show the following 
facts so far as the populations of the Canal Zone, Panama City, and 
Colon are concerned : 

The so-called intestinal group of diseases (typhoid and para-typhoid 
fevers and the dysenteries) are of rare occurrence. The fatality rate 
in diphtheria is very low. While measles is of not uncommon occurrence 
it is but seldom complicated by pneumonias and the fatality rate is low. 
Scarlet fever and meningococcus meningitis but rarely occur. Pneu- 
monia and tuberculosis are very common with high fatality rates. 



28 
VITAL STATISTICS, PANAMA CANAL EMPLOYEES. 

Statistics covering this particular group of the population are quite 
complete. Force reports showing total number of employees are con- 
stantly available and when time is lost on account of illness, record is 
made of that fact. Reports of diagnosis of cases in quarters on 
account of convalescence after hospitalization or on account of minor 
complaints, ordinarily are not recorded in morbidity reports, except in 
the case of malaria. Malaria constitutes the most important cause 
of noneflfectiveness in employees and all clinical cases requiring treat- 
ment by a physician (hospital or quarters) are made the subject of a 
special report and included in the statistics on malaria, and in data 
relating to admission rates to hospitals and quarters and noneffective 
rates. 

In this connection it should be pointed out that during part of the 
period covered by this report, August to December, 1930, a new policy 
was put into effect that should have a tendency to reduce the malaria 
rates among employees. In large construction projects in nonsanitated 
areas, much of the labor is drawn from nearby villages — sometimes a& 
high as 50 per cent — and a considerable number of the laborers drawn 
from such sources are carriers of the malarial parasite but have no 
clinical symptoms. In these projects, not until these laborers became 
ill and upon being sent to the District Physician were found to have 
malaria, have they received treatment for malaria. In August, 1930, 
the policy was adopted of making routine monthly blood surveys of 
laborers engaged on such projects, and administering quinine regularly 
to those found to be positive, irrespective of the fact that they had no 
clinical symptoms. It can be assumed that a certain proportion (just 
what proportion we can not venture to estimate) of the individuals so 
treated would, if not so treated, come down with subjective and objective 
symptoms of malaria at one time or another. The individuals found 
positive for malaria in this group, practically all of whom are residents 
of native villages and employed temporarily by The Panama Canal, 
are not included in the Health Department malaria statistics unless 
they become ill and lose time from their work on account of malaria. 
The routine survey and treatment of this group should tend to bring 
about a slight reduction in general malaria rates in employees. 

It should also be pointed out that statistics relating to employees 
are not representative of a homogeneous geographical group of the 
population. The American white employees of the Canal reside in the 
Canal Zone under hygienic and environmental conditions that are quite 
satisfactory. The Panama Canal, however, employs approximately 



29 



12,000 colored alien individuals only about one-third of whom live 
in the Canal Zone, the remainder, with their families, living in Panama 
City, Colon, and elsewhere, under much less favorable hygienic 
conditions. 

In the interpretation of statistics relating to employees, it is therefore 
necessary to give consideration to the factors outlined above, as well 
as to those mentioned in this report in the introductory paragraph on 
vital statistics for the Isthmus of Panama. (See page 12). 



EMPLOYEES, GENERAL DEATH RATES, ALL CAUSES. 

Death rates among employees from all causes for the period 1906 to 
1930 are incorporated in Table 17: 

Table 17.— EMPLOYEES, DEATHS FROM ALL CAUSES. 

ABSOLUTE NUMBERS AND RATES PEE 1,000 EMPLOYEES. 





Average 


Rate 


Year. 


number 


per 




employed. 


1,000. 


1906 


26,547 


41.73 


1907 


39,238 


28.74 


1908 


43,890 


13.01 


1909 


47,167 


10.64 


1910 


50,802 


10.98 


1911 


48,876 


11.02 


1912 


50,893 


9.18 


1913 


56,654 


8.35 


1914 


44,329 


7.04 


1915 


34,785 


5.77 


1916 


33,176 


6.03 


1917 


32,589 


7.09 


1918 


25,520 


8.11 


1919 


24,204 


7.23 


1920 


20,673 


8.70 


1921 


14,389 


6.46 


1922 


10,447 


6.89 


1923 


10,976 


6.65 


1924 


11,625 


7.23 


1925 


12,180 


8.95 


1926 


12,732 


9.03 


1927 


13,561 


9.00 


1928 


14 , 260 


9.96 


1929 


16,193 


10.37 


1930 


15,524 


11.59 




During the past 8 or 10 years, the tendency has been for general 
death rates for employees to increase, and the rate for 1930 (11.59) was 
the highest experienced since 1908 (13.01). The rates during the 
early construction period were high (1906-1910, 18.63). After com- 
pletion of the Canal when the population became stabilized and the 
employees were still comparatively young, the death rates attained 
their lowest ebb (1921-1925, 7.23). 



30 



During recent years the average age of this group has gradually in- 
creased, a larger proportion of individuals are becoming disabled with 
and dying as the result of, diseases of the so-called chronic degenerative 
type, and the general death rates are gradually increasing (1926-1930, 
10.06). 

EMPLOYEES, DEATH RATES, DISEASE ONLY. 

Death rates from disease only for all Panama Canal employees and 
the racial distribution of these rates (white and colored) are incorpo- 
rated in Table 18: 

Table 18.— EMPLOYEES, DEATHS FROM DISEASE ONLY. 

ABSOLUTE NUMBERS AOT) RATES PER 1,000, WHITE, COLORED, AND TOTAL. 



Year. 


Number of employees. 


Number of deaths from 
disease only. 


Death rate per 1,000, 
disease only. 




White. 


Colored. 


Total. 


White. 


Colored. 


Total. 


White. 


Colored. 


Total. 


1906 


5,106 
10,604 
12,383 
11,662 
13,021 
12,251 
12,553 
11,943 
7,024 
4,719 
4,552 
4,814 
4,408 
4,523 
4,688 
3,855 
■ 2,827 
2,846 
3,055 
3,123 
3,121 
3,197 
3,308 
3,505 
3,589 


21,441 
28,634 
31,507 
35,505 
37,781 
36,625 
38,340 
44,711 
37,305 
30,066 
28,624 
27,775 
21,112 
19,681 
15,985 
10,534 
7,620 
8,130 
8,570 
9,057 
9,611 
10,364 
10,952 
12,688 
11,935 


26,547 
39,238 
43,890 
47,167 
50,802 
48,876 
50,893 
56,654 
44,329 
34,785 
33,176 
32,589 
25,520 
24,204 
20,673 
14,389 
10,447 
10,976 
11,625 
12,180 
12,732 
13,561 
14,260 
16,193 
15,524 


■19 
97 
90 
75 
64 
72 
58 
43 
47 
15 
15 
22 
16 

8 
17 
10 
10 
15 
13 

9 

18 
19 
19 
23 
27 


1,024 

848 

291 

281 

317 

302 

266 

254 

265 

12S 

137 

165 

166 

142 

136 

72 

54 

52 

51 

85 

77 

87 

112 

128 

148 


1,043 

945 

381 

356 

381 

374 

324 

297 

312 

141 

152 

187 

182 

150 

153 

82 

64 

67 

64 

94 

95 

106 

131 

151 

175 


3.72 
9.15 
7.27 
6.43 
4.92 
5.88 
4.62 
3.60 
6.69 
3.18 
3.29 
4.57 
3.63 
1.77 
3.63 
2.59 
3.54 
5.27 
4.26 
2.88 
5.77 
5.94 
5.74 
6.56 
7.52 


47.76 
29.62 
9.24 
7.91 
8.39 
8.25 
6.94 
5.68 
7.10 
4.19 
4.79 
5.94 
7.86 
7.21 
8.51 
6.83 
7.09 
6.40 
5.95 
9.39 
8.01 
8.39 
10.23 
10.09 
12.40 


39.29 


1907 


24.08 


1908 


8.68 


1909 


7.55 


1910 


7.50 


1911 

1912 

1913 


7.65 
6.37 
5.24 


1914 


7.04 


1915 


4.05 


1916 


4.58 


1917 


5.74 


1918 


7.13 


1919 


6.20 


1920 


7.40 


1921 


5.70 


1922 


6.13 


1923 


6.10 


1924 


5.51 


1925 


7.72 


1926 


7.46 


1927 


7.82 


1928 

1929 


9.19 
9.33 


1930 


11.27 







" Americans only. 

The point of greatest interest disclosed by the table is the consist- 
ently low death rates in white employees as compared with colored. 
This can best be visualized by comparing the rates by race, for 5- 
year periods; the following periods include the latter years of the con- 
struction period and the three 5-year periods from 1916 to 1930. 





1908-1912. 


1916-1920. 


1921-1925. 


1926-1930. 




5.8 
8.1 


3.5 

6.6 


3.5 
7.2 


6.3 




9.9 











The death rates in colored employees range from 40 per cent to 100 
per cent higher than those in white employees. The comparatively 
low rates in white employees are attributable to many factors favorable 



31 



to such employees, among which may be mentioned : Rates of pay, scale 
of living, physical stamina, intelligence, education, and hygiene and 
sanitation in the home and immediate environment. Another im- 
portant factor is that while in both racial groups the average age has 
gradually increased to such an extent that diseases of the so-called 
chronic degenerative type are becoming more common, they are affect- 
ing the colored employees porportionately to a greater degree than 
white employees, and increasingly larger numbers of colored employees 
are dying of such disease while still in active service. 

It is to be noted that the death rates from disease in both groups of 
employees are attaining higher levels. The factors which probably 
account for this increase are set forth in the general discussion of the 
interpretation of vital statistics for the Isthmus appearing in this 
report. 

PRINCIPAL CAUSES OF DEATH OF PANAMA CANAL 
EMPLOYEES. 

The six principal causes of death among Panama Canal employees 
for the years 1920-1930 are included in Table 19: 

Table 19.— PRINCIPAL CAUSES OF DEATH, EMPLOYEES ONLY. 





1920. 


1921. 


1922. 


1923. 


1924. 


1925. 


1926. 


1927. 


1928. 


1929. 


1930. 






1 




1 




1 


Is 
Q 


1 


1 
Q 


1 


"Si S 




1 


1 


1 


Q 


1 


"ci 
p 


1 





d 

rt 


Tuberculosis (various organs) 


30 


1.45 


11 


.7612 


1.15 


9 


.8212 


1.03 


131.0719 


1.49 


11 


.81 


12 


.84i2 


.74 23 


1.48 


Pneumonia (broncho and lobar) . . 


22 


1.06 


7 


.49 






7 


.64 


5 


.43 


9 


.74 


10 


79 






17 


1.19231.4216 


1 03 
















21 


1.02 












































































! 




Nephritis (acute and chronic) 


13 


.63 


9 


.63 


4 


.38 


9 


.82 


7 


.60 8 .66 


13 


1.0216 


1.18 


11 


.77|13 


.80 


19 


1.22 


Organic diseases of the heart 


11 


.5314 


.97j 9 


.86 


8 .73 


6 .'i2ii4:i 1."; 






14 


1 na'ii 


.77|l5 


.93 


17 


1 10 




1 : 


4 












5 


.24 


6 


.42 


6 


.57 


3 


.27 


5 


.43 


9 74 


.31 


6 


.44 


12 


.84 






























* 


.27 
















































































6 


57 4I 3fi 


6 


.52 


6 


.49 


3 


.24 


8 


.59 






10 


621.'? 


84 






































4 


..38 


































































































16 


1.2610 


.74151 Oii 19 


1 17 


17 


1 10 















































ADMISSIONS OF EMPLOYEES TO HOSPITALS AND 
QUARTERS. 

The basic data from which admission to hospitals and quarters are 
compiled and the types of cases included are explained in the general 
discussion of vital statistics for Panama Canal employees appearing on 
page 12 of this report. 



32 



The annual rates for the period 1906-1930 are shown in Table 20; 

Table 20.— Employees, Admissions to Hospitals and Quarters from all 

Causes. 

NUMBBB AND RATES PER 1,000 EMPLOTEES. 





Average 


Rate 


Year. 


number 


per 




employed. 


1.000. 


1906 


26,547 


1,779 


1907 


39,238 


1.419 


1908 


43,890 


1,132 


1909 


47,167 


887 


1910 


50,802 


905 


1911 


48,876 


896 


1912 


50,893 


727 


1913 


56,654 


519 


1914 


44.329 


420 


1915 


34,785 


320 


1916 


33,176 


283 


1917 


32,589 


357 


1918 


25,520 


406 


1919 


24,204 


550 


1920 


20,673 


672 


1921 


14,389 


620 


1922 


10,447 


490 


1923 


10,976 


485 


1924 


11,625 


513 


1925 


12,180 


519 


1926 


12,732 


474 


1927 


13,561 


502 


1928 


14,260 


595 


1929 


16,193 


602 


1930 


15,524 


603 





The average age of both white and colored employees is gradually 
increasing and, as is to be anticipated under such conditions, the 
admission rate to hospitals and quarters has increased slightly from 
year to year during the past five years. 

The admission rate per 1,000 to hospitals for disease by race (white 
and colored) has been as follows for the past five years : 

ADMISSION RATE PER 1,000 EMPLOYEES, BY RACE (WHITE AND COLORED). 



Year. 



White. 



Colored. 



1926. 
1927. 
1928. 
1929. 
1930 



221 


101 


209 


95 


240 


128 


273 


154 


288 


180 



PRINCIPAL CAUSES OF ADMISSION OF EMPLOYEES 
TO HOSPITALS. 

The six diseases causing the greatest number of admissions of em- 
ployees to hospitals during the past five years are incorporated in 
Table 21: 



33 



Table 21.— EMPLOYEES. PRINCIPAL CAUSES OF ADMISSIONS TO HOSPITALS. 





1926. 


1927. 


1928. 


1929. 


1930. 




Total. 


Rate 
1,000 


Total. 


Rate 
1,000 


Total. 


Rate 
1,000 


Total. 


Rate 
1,000 


Total. 


Rate 
1,000 


Malaria (including the few cases treated 


179 
102 


14 

8 


146 
127 


11 
9 


203 
121 
49 
103 
70 
94 


14 

8 
4 

7 
5 

7 


337 
184 
153 
113 


21 
11 
9 

7 


410 
136 


26 




9 








62 
61 


5 
5 


84 
57 
66 


6 
4 
5 








150 
130 
113 


10 




121 


7 


8 








7 




69 
52 


5 
4 


















41 


3 




















109 


7 


106 


7 



















NONEFFECTIVE RATES, ALL CAUSES, EMPLOYEES. 
These rates are shown in Table 22: 

Table 22. — Noneffective Rate from All Causes, Employees. 

RATES PER 1,000. 



Year. 



1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 
1925 
1926 
1927 
1928 
1929 
1930 



Average 
number 
employed. 



26,547 
39,238 
43,890 
47,167 
50,802 
48,876 
50,893 
56,654 
44,329 
34,785 
33,176 
32,589 
25,520 
24,204 
20,673 
14,389 
10,447 
10,976 
11,625 
12,180 
12,732 
13,561 
14,260 
16,193 
15,524 



Rate 

per 

1,000. 



28.48 
25.09 
22.31 
21.93 
24.37 
24.46 
21.11 
15.97 
12.22 
10.28 
9.20 
9.65 
11.19 
14.29 
14.87 
13.96 
14.81 
13.78 
13.51 
13.77 
12.08 
13.81 
14.66 
15.23 
14.90 



Noneffective rates apparently have become stabilized and variations 
m the rates for the past ten years have been but slight. 



MR 26916- 



34 



ADMISSION RATES, MALARIA, HOSPITAL AND QUARTERS, 

EMPLOYEES. 

As malaria is the most important disease problem with which the 
Health Department must contend on the Isthmus, every effort is made 
to diagnose and report in morbidity statistics all clinical cases seen by 
Panama Canal physicians. Statistical records of cases of malaria 
occurring in employees are the most accurate and complete that are 
compiled for any special group of the population residing on the Canal 
Zone except military personnel, as employees absent from duty must 
secure a certificate from a physician to cover absence on account of 
illness in order to be paid for time lost therefrom. 

The admission rates per 1,000 per annum for all employees for the 
years 1906 to 1930 inclusive, are incorporated in Table 23: 

Table 23. — Malaria Cases, Employees Only. 

ABSOLUTE NUMBERS AND RATES PER 1,000 BMPLOTEES. 





Average 


Number 


Rate 






Year. 


number 


of 


per 








employed. 


cases. 


1.000. 






1906 
1907 
1908 


26,547 
39,238 
43,890 


21.795 
16,637 

12,372 


821 

424 
282 










1909 


47,167 


10,169 


215 






1910 


50,802 


9,487 


187 


■§■^■■■1 




1911 


48,876 


8,987 


184 


■■■■■H 




1912 


50,893 


5,623 


110 


WK^^KKM 




1913 


56,654 


4,284 


76 


^■■■B 




1914 


44,329 


3,635 


82 


■■■■■ 




1915 


34,785 


1,781 


51 


DIB^HI 




1916 


33,176 


547 


16 


Hm 




1917 


32,589 


473 


14 


I^HI 




1918 


25,520 


472 


18 


mB 




1919 


24,204 


752 


31 


^gg^H 




1920 


20,673 


401 


19 


■■■1 




1921 


14,389 


214 


15 


^gg 




1922 


10,447 


176 


17 


WK^M 


^ 


1923 


10,976 


212 


19 


^■■1 




1924 


11,625 


190 


16 


HUH 




1925 


12,180 


330 


27 


H^^H 




1926 


12,732 


179 


14 


■■1 




1927 


13,561 


145 


11 


BBI 




1928 


14,260 


203 


14 


■^B 




1929 


16,193 


337 


21 


g^lB 




1930 


15,524 


410 


26 


■■■ 





When malaria control measures (drainage, oiling, screening, etc.) on 
a large scale are first carried out in heavily infected areas in various 
parts of the world the initial reduction in malaria is spectacular. Such 
a reduction occurred in employees of The Panama Canal during the 
construction period when the malaria rates were gradually reduced from 
821 cases per 1,000 in 1906 to 76 in 1913. After the opening of the 



35 

Ganal for traffic in 1914, the population became stabilized and between 
1916 and 1930 the annual rate per 1,000 has ranged between 11 and 31,. 
It may be said that the rate of malaria in employees under normal con- 
ditions, when large field projects are not being undertaken in nonsani- 
tated areas, ranges from about 14 to 19 cases per 1 ,000 of employees each 
year. Notwithstanding the continuous extension of areas under sani- 
tary control during the past 15 years, it becomes increasingly difficult to 
reduce rates further. The high rates prevailing in 1925, 1929, and 
1930 were due to the fact that large construction projects, beyond the 
sanitated areas, were under way. In 1925 a large construction project 
in a nonsanitated area at Bruja Point was undertaken for the Army. 
In 1928 construction of the Madden Dam road was begun, and field 
parties were in the Madden Dam area making surveys preparatory to 
construction of the dam; these two projects were continued during 1929 
and 1930, and in addition construction work was begun on the Thatcher 
Highway. The Madden Dam road was completed in 1930, but the 
other field projects were being continued during 1930. The result has 
been that the malaria rates increased to 21 per 1,000 employees in 
1929 and to 26 in 1930. When such projects are undertaken it is cus- 
tomary to draw a considerable proportion (sometimes 50 per cent or 
more) of the labor from nearby villages. Many of these laborers 
have chronic malaria when employed, and many of them return to 
their homes at night. The usual control measures carried out on such 
projects are screening of habitations, elimination of breeding places in 
the immediate vicinity of the camp, catching of adult mosquitoes 
inside barracks every morning, hospitalization of individuals with 
malaria, and the provision of an ample, varied, nutritious diet for 
the laborers. Considering the conditions under which these projects are 
carried out and the degree to which the laborers are exposed to malarial 
infection, it is quite remarkable that the infection rate can be held at 
so low a point. 

Excluding the malaria occurring in individuals engaged on field proj- 
ects, the rates for the three years under discussion would be: 1925, 17 ; 
1929, 14; 1930, 19. That substantial progress is being made in reduc- 
ing the prevalence of malaria among employees, is evident when we 
exclude from consideration these cases chargeable to field projects in 
nonsanitated areas. On this basis, the average annual rate per 1,000 
employees for the 5-year period 1921-1925 was 17, whereas for the 
5-year period 1926-1930 it had declined to 14. 

The lowest rate so far attained in Canal Zone employees was that of 
11 per 1,000 in 1927. 



36 

The malaria season for 1930 was one of the worst that has been ex- 
perienced in the Canal Zone and throughout the Republic of Panama 
for some years, and was due to a somewhat unusual rainy season. The 
rains began in May, continued for a short time, and were followed by 
a somewhat extended so-called "short dry season" or "St. John's 
summer." This produced ideal conditions for the breeding of malaria 
transmitting mosquitoes throughout the entire Republic of Panama. 



37 



a H 



si 




10.69 
9.26 
5.90 
5.11 
5.27 
5.23 
3.56 
4.90 
1.93 
4.49 
3.66 
6.34 
4.24 
2.66 
7 48 








o 














£ 

O 

o 


13.10 
13.89 
5.15 
4.47 
7.60 
4.36 
3.13 
2.24 
2.11 
5.11 
5.45 
5.76 
4.88 
3.08 








■>«< 








" 




1 


2.76 
4,34 
6,61 
5.98 
3.07 
6.23 
4.00 
6.77 
1.59 
3.30 


» 




03 
US 






00 
00 
















S3 
1 

i 
PS 


1 


8.78 

3.92 

1.66 

1.10 

.98 

.96 

.39 

.37 

.16 

.23 

.06 

.09 

.08 

.08 

,15 






- 








to 

o 




1 
O 


10.21 
4.16 
,98 
,73 
.93 
.57 
.23 
.25 
.13 
.20 
.07 
.07 
.09 
.10 








<M 








°. 




1 


2,74 

3,30 

3.39 

2.23 

1,15 

2.12 

.88 

.84 

.28 

.42 


^. 




s 






n 














"a 

e 

o 
<1 




m»J<C0<MO(^O-<t^00IMMCqiNC0 






« 








■^ 




1 

"o 
O 


T-H ,-* C*5 C^ CO C<1 .-I 








^^ 








*"* 




.1 


-<J^W5C^COU5CO»-lOC<IC^ 






M 






■ 














S 

.1 

1 


1 

1 
o 

s 

o. 

s 


"s 
1 


QO ■* C^l <M rt rt -H 


-d 
§ 
O 


t^ (N -H T-H ^ r-. 


1 


»O'-HC0CC»O»-IOSrJ*Oi00OC0-Tfic00000OO00t^0se<l!DOC0 


1 

3 

a 
S 

3 


1 






SSS2°^°°"'"*"'~' 




1 

_o 

a 




t-ocs?o-*o»o»nco--it^oooos 


coootowsM-Ttic^c^cq-^ 




i 






lOOOtO-*-<f-*(Mr-lrt 






1 
1 

5 

i 

3 


"a 
"o 


26,547 
39,238 
43,890 
47,167 
50,802 
48,876 
50,893 
56,654 
44,329 
34,785 
33,176 
32,589 
25,520 
24,204 
20,673 
14,389 
10,447 
10,976 
11,625 
12,180 
12,732 
13,561 
14,260 
16,193 
15,524 


-a 

o 

o 
O 


21,441 
28,634 
31,507 
35,505 
37,781 
36,625 
38,340 
44,711 
37,305 
30,066 
28,624 
27,775 
21,112 
19,681 
15,985 
10,534 
7,620 
8,130 
8,570 
9,057 
9,611 
10,364 
10,952 
12,688 
11,935 


3 
^ 


5,106 
10,604 
12,383 
11,662 
13,021 
12,251 
12,553 
11,943 
7,024 
4,719 
4,552 
4,814 
4,408 
4,523 
4,688 
3,855 
2,827 
2,846 
3,055 
3,123 
3,121 
3,197 
3,308 
3,505 
3,589 




2 




ggggc>-Hecic<5->i<>o«s«^ooo 


;§?5§is3^^ssicSS^ 


S2S22222222 


3 010 


30 





38 



The interesting point shown in the racial distribution of malaria in 
Panama Canal employees is the fact that admission rates per 1,000 are, 
as a rule, higher in white employees than in colored. This statement 
holds good for each year of the period 1906-1930, except for the years 
1918, 1919, 1920, 1929, and 1930. In 1925 the rates were the same. 

This finding supports other epidemiological evidence which suggests 
strongly that the inhabitants of tropical countries in which malaria 
has been of common occurrence for centuries, gradually have acquired 
a tolerance or immunity to the disease and that it is the new arrival 
from nonmalarial countries who suffers most severely. 



DEATH RATES, MALARIA, EMPLOYEES. 

The death rates from malaria, Panama Canal employees, are shown 
in Table 25 : 





Table 


25. — Deaths from Malaria among Employees Only. 

ABSOLUTE NUMBERS AND RATES PER 1,000 BMPLOTEES. 


Year. 


Average Number 
number of 
employed, deaths. 


Rate 

per 

1,000. 




1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 
1919 
1920 
1921 


26,547 
39,238 
43,890 
47,167 
50,802 
48,876 
50,893 
56,654 
44,329 
34,785 
33,176 
32,589 
25,520 
24,204 
20,673 
14,389 
10,447 
10,976 
11,625 
12,180 
12,732 
13,561 
14,260 
16,193 
15,524 


233 
154 

73 

52 

50 

47 

20 

21 

7 

8 

2 

3 

2 

2 

3 


8.78 

3.92 
1.66 
1.10 
.98 
.96 
.39 
.37 
.16 
.23 
.06 
.09 
.08 
.08 
.15 






• 

llll 


1922 








1923 








1924 
1925 


2 


.17 


■ 


1926 








1927 








1928 








1929 
1930 


1 


.06 


■ 











As will be noted from the table, a death from malaria among em- 
ployees but seldom occurred during recent years. No death attribut- 
able to malaria occurred among Panama Canal employees during 1930. 

It is well known that estivo-autumnal (so-called malignant type) 
malaria is the type of most common occurrence on the Isthmus, and 
that not infrequently it manifests itself clinically as the cerebral form 



39 



which may be fulminating and quickly result in death. When indi- 
viduals report with temperatures above normal, every effort is made to 
ascertain if they have malaria as quickly as is practicable. When a 
death from malaria does occur it usually is found that the individual 
has delayed in reporting for treatment and is en extremis when first 
seen by a physician. 

It has been possible to analyze death rates in employees by race 
(white and colored) and the data covering the matter are incorporated 
in Table 24, page 37. These data show that except for the first two 
years of the construction period (1906-1907), malaria is much more 
likely to result in death in white employees than in colored. This 
supports the theory that the inhabitants of tropical countries in which 
malaria is endemic acquire a tolerance to the disease. The fatality 
rates from malaria by race, which are also included in Table 24, further 
support this assumption. 

The influence of race, which indicates in reality previous residence, 
on incidence rates, mortality rates, and fatality rates, can best be ap- 
preciated by consolidating them for a number of years. This has 
been done in the following table. 

Table 26.— MALARIA, EMPLOYEES ONLY, ADMISSIONS AND DEATHS BY RACE— HOSPITALS 

AND QUARTERS. ■ 

ABSOLUTE NUMBERS, MORBIDITT AND MORTALITY RATES PER 1,000 EMPLOYEES AND FATALITY RATES PER 1,000 CASES. 



Period. 



1906 and 1907. . 
1908 to 1914 

inclusive 

1915 to 1930 

inclusive 



Ntimber of 
employees. 



15,71050,075 
80,837i261,774 
60,130^42,704 



65,785 
342,611 
302,834 



Admissions. 



Deaths. 



Absolute 
numbers. 



O 



Rate per Absolute 
1,000 em- numbers. 

ployees. 



13 , 151 25 , 341 38 , 492 837506 585 
25,24129,316:54,5573121112159 

^ i ! 

1,783 5,039 6,822 30 21 23 



Rate per 1,000 
employees. 



3.12 
1.63 
.116 



o 



6.75 
53 
066 



.79 
.076 



Fatality rates 

per 1,000 

cases. 



3.73 
5.23 
3.93 



o 



13.34 
4.71 
3.18 



10.05 
4.95 
3.37 



» Records 1906-1913 cover oases in hospitals only. Records 1914-1930 cover cases in hospitals and quarters. 

The 2-year period 1906-1907 is treated separately, as the death rates 
and fatality for colored employees were much higher during those years 
than for whites which is quite contrary to experience with the disease 
in Panama Canal employees in subsequent years. The remaining 
years (1908-1930) are divided into two periods, as the records for 1908- 
1914 include only the cases admitted to hospitals whereas the latter 
group (1915-1930) includes both hospital and quarters cases. It will 
be noted that for the entire period (1908-1930) malaria has occurred 
with greater frequency in the white group, though during recent years 
there has been an increasingly greater tendency for admission rates 
for the two races to become equalized. Both death rates and fatality 



40 

rates have been persistently higher in white employees. Since 1920 
the death of an employee from malaria has been an unusual occurrence 
and attributable usually to delay in reporting for treatment. 

DIVISION OF HOSPITALS, DISPENSARIES, AND CHARITIES. 

The administrative units (hospitals and dispensaries) making up 
this division of the Health Department function directly under the 
supervision of the Chief Health Officer. 

The Panama Canal maintains two general hospitals to meet the medi- 
cal and surgical requirements of the population residing in the Canal 
Zone (Panama Canal employees and their dependents. Army personnel, 
other Government employees, and others entitled to treatment). 

Gorgas Hospital (formerly known as Ancon Hospital) constructed 
at a cost of $2,000,000 with a normal capacity of 800 patients, is 
located in Ancon on the Pacific side, and Colon Hospital, constructed 
at a cost of $255,000 with a capacity of 130 patients, serves the popu- 
lation at the Atlantic terminal. 

The insane from the populations of the Canal Zone and the Repub- 
lic of Panama are cared for in an asylum for the insane maintained by 
the Health Department at Corozal, two miles north of Balboa, near 
Miraflores Locks. The number of insane cared for at the expense of 
the Republic of Panama (75 cents per capita per day) is increasing 
rapidly, as the country is being opened up through the development and 
extension of roads into the interior. On December 31, 1930, a total of 
598 insane were inmates of the asylum (Canal Zone and miscellaneous 
patients 145; Republic of Panama patients 453). On December 31, 
1926, the comparable numbers were: Total patients 480 (Canal Zone and 
miscellaneous patients 126; Republic of Panama patients 354). This 
institution is now overcrowded but a new ward is under construction. 

All cases of leprosy arising in the Canal Zone and in the Republic of 
Panama are treated in the Palo Seco Leper Colony, maintained by the 
Health Department of The Panama Canal in an isolated locality on 
the west side of the Canal at the Pacific terminal. During the past 
few years there has been but little change in the number of lepers 
treated at the colony. The census on December 31, 1930, was 99 cases, 
and on December 31, 1926, 102 patients. 

The Health Department maintains dispensaries in the more impor- 
tant permanent towns, staffed by from 1 to 3 physicians and the neces- 
sary number of dispensary assistants, chauffeurs and attendants. 
The physicians on duty in these dispensaries have regular office hours 
during which employees and their families consult them free of charge. 

In addition to the charity work done in its general hospitals and in 
the institutions maintained for the care of the insane and lepers, the 







~ a 



■2Z 



-0-T3 
< 5= 



a" -2 



41 

Health Department also cares for crippled employees, those suffering 
from chronic disabling diseases and those unable to work on account of 
advancing age, in a special department located on the reservation of 
the Corozal Hospital for the insane and administered under the direc- 
tion of the superintendent of that institution. 

The annual reports of the various institutions comprising this divi- 
sion of the Health Department follow: 

GORGAS HOSPITAL. 

(Normal capacity 800 persons.) 
Col. Arthur M. Whaley, Medical Corps, U. S. Army, Superintendent. 

Administration. — The central location of the hospital admitting office 
and emergency station on the first floor of the Administration-Clinics 
building has been very satisfactory. Much better service is rendered 
incoming patients than formerly when this activity was located in the 
Ancon Dispensary building. The admission of patients has been fur- 
ther facilitated by removal of the bookkeeper and cashier from the 
second floor to a space adjacent to the new admitting office. 

In June a "message center" was instituted, also located on the first 
floor of the Administration-Clinics building. Colored male orderlies 
formerly used in each section as messengers, were transferred to the 
message center and placed in charge of a white nurse who also functions 
as an information clerk. This change has not only resulted in greater 
efficiency in handling patients and papers to and from hospital services 
and sections, but in considerable economy as well. It has been possible 
to conduct this class of work satisfactorily with a smaller number of 
orderlies than previously required. 

Buildings and equipment. — The addition to the nurses quarters was 
completed by the Constructing Quartermaster at a cost of about 
$90,000 and the building turned over to the hospital for occupancy on 
October 10. Considerable finishing work was left for performance by 
hospital artisans as time and funds permit. 

In May the refrigerating plant in the hospital main kitchen was re- 
built by the Mechanical Division at a cost of $2,600. In July, the 
shop and parts storeroom of the general mechanic were removed from 
the basement of the main kitchen building to the central section of the 
shops' building formerly the site of the hospital bakery; a large sky- 
light was installed and storage racks and bins set up. In November 
the old manually operated telephone system was replaced by modern 
automatic equipment, supplemented by a code call system. 

Although there were no very large items of equipment purchased 
during the year, various items of new apparatus and equipment were 
received and placed in service. Among these were: Ophthalmoscope 



42 

for the eye, ear, nose and throat service. 10-gallon water still with 20- 
gallon storage tank for the Board of Health laboratory, high frequency 
apparatus for physio-therapy service, intensifying screens for X-ray 
department, large food conveyors, three steel desks, etc. 

Maintenance and repairs. — Climatic conditions necessitate constant 
attention and much work to prevent deterioration of hospital buildings 
and equipment. The routine work of maintenance and repair, including 
repainting of furniture and equipment throughout the hospital and 
repair of elevators and electrical equipment, was done by hospital 
artisans. In addition, considerable new work was completed and 
many items of furniture and equipment were manufactured for the 
hospital and other Health Department subdivisions. Of these, the 
more important items were: 

Section "A" — Twelve pairs of windows fitted and hung; 2 portable 
screens manufactured. Section "C" — Eleven clothes lockers; 2 ma- 
hogany desks. Section "D" — Concrete walls washed and new floors 
placed in four rooms. Isolation section — Entire section repainted; 1 
examining table, and 1 table for pneumothorax apparatus manufactured. 
Physio-therapy service — One treatment table. Main hospital kitchen — 
One mahogany desk; steam tables relocated and repaired; extension to 
garbage room; concrete partitions removed in basement rooms which 
were adapted for kitchen purposes. Dental service — Fifteen drawer 
5x3 index card file. X-ray — Ten drawer 5x3 card index file. Ad- 
ministration-Clinics building — Office for bookkeeper and cashier in- 
stalled on first floor; concrete walls washed; one 4-drawer 5x3 card 
index file. Board of health laboratory — One bookcase. Undertaking 
department — Thirty-six size 1, 120 size 2, and 24 size 4 plain coffins 
manufactured, also a shipping box for transfer of bodies. Motor 
vehicles — New body and repainting, U. S. truck No. 823; woodwork 
renewed and bodies repainted, ambulance No. 327 (Pedro Miguel 
dispensary), U. S. No. 845 (Balboa dispensary) and U. S. No. 846 
(Balboa quarantine station) ; body repairs and repainting, hospital 
ambulances No. 830, 847, and 848. Miscellaneous — Three wheeled- 
stretchers for Gorgas Hospital and one for Colon Hospital were manu- 
factured by the general mechanic. A bookcase and table were manu- 
factured for Pedro Miguel dispensary, a table for Ancon sanitary office 
and a new litter for Balboa dispensary. 

DETAILS OF PROFESSIONAL SERVICES RENDERED. 

Surgical service. — There were 2,027 major operations (with 27 
deaths), 1,788 minor operations, and 4,419 intravenous injections of 
arsphenamin; 532 obstetrical cases were delivered, in which there were 



45 



7 twin births and 32 stillbirths; 11,040 cases visited the out-patient 
department. 

Medical service. — There were 9,668 cases treated in the out-patient 
department. 

Dental service. — There were 3,774 sittings during the year; 1,187 oral 
examinations and surveys; 1,217 teeth extracted. Four hundred and 
seventeen complete and 425 partial X-ray examinations were made 
during the year. 

Eye, ear, nose and throat service. — There were 10,476 visits to the out- 
patient department; 2,752 operations were performed and 1,535 re- 
fractions were done. 

Radiographic service. — There were 6,107 cases handled for which 
14,688 films of various sizes were used and in which 821 fluoroscopic 
examinations were made. 

Physio-therapy service. — Treatments were given 921 out-patients and 
762 hospital in-patients in this service during the year. 

Nonresidents. — There were 527 patients, whose residences were out- 
side of the Canal Zone or the cities of Panama and Colon, treated in 
Gorgas Hospital during the year. There were 9,810 hospital days and 

8 deaths in this group. 

SURGICAL OPERATIONS. 



Number. 



Died. 



Amputations: 

Hand 

Leg .' 

Foot .••. 

Digits, multiple 

Operations on bones: 

Craniectomy, decompressive .... 

Craniectomy, exploratory 

Laminectomy 

Ostectomy 

Excision of maxilla 

Wiring of fracture, simple 

Wiring of fracture, compound. . . 

Reduction of fracture, simple. . . 

Reduction of fracture, compound 

Plating of fracture, simple 

Bone graft 

Open reduction, patella 

Adenectomy: 

Cervical 

Axillary 

Inguinal, single 

Inguinal, double 

Femoral 

Herniotomy: 

Inguinal, single 

Inguinal, double 

Femoral 

Ventral 

Strangulated 

Diaphragmatic 

Umbilical 

Genito-Urinary tract: 

Nephrotomy 

Nephrectomy 

Nephropexy 

Cystotomy 

Urethrotomy, internal 

Urethrotomy, external 



1 
3 
1 

7 

2 
1 
1 

3 
1 
4 
1 

75 
2 
8 
1 
1 

1 

3 

196 

36 

10 

110 
20 
1 
11 
4 
1 
1 

2 
4 
6 
5 
3 
4 



44 



SURGICAL OPERATIONS— Continued. 



Number. 



Genito-Urinary tract — Continued: 

Prostatectomy 

Varicocele, radical cure 

Hydrocele, single, radical cure 

Hydrocele, double 

Orchidectomy 

Epididymotomy 

Vasectomy 

Amputation of penis 

Curetage uteri 

Perineoplasty 

Trachelorrhaphy 

Vaginal puncture 

Bevan operation for undescended testis 

Obstetrical: 

Cesarean section, abdominal .• 

Cesarean section, vaginal 

Low forceps 

Version 

Manual extraction of placenta 

Thorax: 

Thoracotomy 

Thoracoplasty 

Excision of breast 

Excision of breast and axilla 

Rectum: 

Hemorrhoids, radical cure 

Prolapsus recti, radical excision 

General: 

Thyroidectomy 

Varicose veins, excision of 

Tenorrhaphy , 

Excision of surface neoplasms 

Plastic operation for congenital defect 

Plastic operation for effects of severe injury 

Plastic operation for effects of disease 

Skin graft 

Laparotomy: 

For general peritonitis (not traumatic or appendicial) 

For intestinal obstruction 

Exploratory 

Gastrectomy 

Gastrotomy 

Gastro-enterostomy 

Entero-enterostomy 

Enterectomy 

Enterorrhaphy 

Appendectomy 

Appendectomy, with local peritonitis ^ 

Appendectomy, with general peritonitis 

Sigmoidopexy 

Cholecystectomy 

Cholecystotomy 

Cholecystostomy 

Choledochectomy 

Excision of gastric ulcer 

Abscess of liver, laparo-hepatotomy for 

Pan-hysterectomy 

Supravaginal hysterectomy 

Hysteromyomectomy 

Myomectomy 

Salpingostomy, single 

Salpingostomy, double 

Salpingo-oophorectomy 

Ovarian cystostomy 

Oophorectomy 

Suspensio uteri 

Plastic operation for chronic peritonitis 

Operation for ectopic gestation 

Pyloroplasty 

Laparotomy for stab wound of abdomen 

Various other major operations 

Various minor operations 

Cauterizations 

Circumcisions 

Salvarsan injections 

Blood transfusions 

Obstetrical cases handled 

in which there were — 

Twin births 7 

Stillbirths 32 



3 

. 4 

36 

1 

4 

127 

4 

1 

305 

24 

13 

12 

2 

12 
1 
7 
2 
1 

4 
1 
3 

2 

119 
2 

12 
1 
3 
1 
2 
1 

11 
1 

1 

5 

16 

1 

1 

6 

2 

2 

6 

368 

17 

2 

1 

12 
2 
8 
2 
1 
1 

17 

53 

32 

2 

28 

19 

27 

4 

36 

99 

1 

1 

1 

1 

5 

1,381 

39 

367 

4,419 

1 

532 



45 



EYE, EAR, NOSE AND THROAT OPERATIONS. 



Eye: 



Ear: 



Advancement 1 

Cataract extraction, simple 4 

Cataract extraction, combined 4 

Chalazion removal 28 

Conjunctival flap 1 

Enucleation 6 

Foreign body, removal of 61 

Hordeolum, incision of 9 

Iridectomy 3 

Lachrymal operations — 

Dilatation of ducts 2 

Lid operations^ 

Expression of lids 1 

Plastic 1 

Minor lid operations 4 

Needling 5 

Paracentesis 1 

Pterygium 69 

Refractions 1 , 535 

Sclerotomy 1 

Trephine, scleral 2 

Varioiis other eye operations 2 

Minor eye operations 7 

Furuncle, incision 6 

Foreign body, removal of 10 

Mastoid operation, simple 22 

Paracentesis 39 

Tumor inner ear, removal of 1 



Ear — Contmued : 

Post-auricular abscess 1 

Removal of keloids 2 

Minor ear operations 7 

Nose: 

Foreign body, removal of 7 

Polypi, removal of 14 

Rhinoplasty 1 

Sinus, ethmoid, simple 9 

Sunus, frontal, simple 7 

Sinus, maxillary, puncture and irrigation . . 70 

Sinus, maxillary, radical 20 

Sinus, sphenoid, simple 8 

Reduction of fracture 1 

Spur removal 1 

Submucus resection 121 

Turbinectomy 4 

Minor nose operations 4 

Pharynx: 

Adenoideetomy ■. • ■ •. ^^^ 

Peritonsillar abscess, incision of 28 

Tonsillectomy 1 , 410 

Esophagoscopy 1 

Minor pharyngeal operations 3 

Larynx: 

Laryngoscopy 2 

Tumors, removal of 2 

Trachea: 

Tracheotomy 3 

Other miscellaneous operations 1 



X-RAY SERVICE. 



Total number of cases handled 6, 

Nature of examination: 

Abdomen 22 

Ankle 102 

Chest 2,224 

Colon 23 

Elbow 77 

Face 5 

Femur 62 

Fluoroscopy 29 

Fluoroscopy (with G. I. series) . . . 792 

Foot 162 

Forearm 123 

Foreign body 2 

Gallbladder 147 

Gastro-intestinal series 391 

Gastric 4 

Genito-urinary tract 305 

Hand 219 

Hip 85 



Nature of examination — Continued: 

Humerus 15 

Jaw 79 

Knee 138 

Leg 105 

Liver 1 

Mastoid 84 

Neck 4 

Esophagus 5 

Pelvis 17 

Shoulder Ill 

Sinuses 319 

Skull 153 

Spine 205 

Wrist 102 

Classification of films used: 

8x 10 3,286 

lOx 12 4,610 

14x 17 6,792 



PHYSIOTHERAPY SERVICE. 



Department. 



Number treated. 



Hospital 
patients. 



Out- 
patients. 



Number of 

treatments 

adminLstered. 



Radium: 

Malignant 33; nonmalignant 66 

Roentgen-therapy : 

Malignant 39; nonmalignant 201 

Physiotherapy: 

(Electro- therapy, diathermy, quartz light, etc.) 

Hydrotherapy 

Phototherapy 

Massage 

Bakmg 

Miscellaneous 



39 

SO 

268 

197 

91 

98 

18 

1 



190 

364 
198 
34 
47 
26 
2 



1,185 

4,596 
2,727 
1,221 
1,853 
341 
16 



46 



DENTAL SERVICE. 



Total number of sittings 

Abscess, periapical 

Abscess, alveolar 

Abscess lanced. . . . 

Calculus removed 

Caries 

Fractured mandible 

Wiring of 

Treatments of 

Gingivitis 

Treatments of 

Oral examination, clinic 

Oral survey, clinic 

Oral examination, ward 

Oral prophylaxis 

Peridontoclaaia 

Treatments for 53 

Postoperative treatments 



37 



5 
550 



102 



7 
53 

46 

4G3 
16 



977 

200 

10 

81 

34 

191 



3 , 774 Stomatitis, Vincents 

Smears to laboratory 35 

Teeth, extractions (No. of teeth) . 

Treatments 36 

Anesthesia, conductive 

Anesthesia, infiltrative 

Fillings: 

Amalgam 

Amalgam-cement 

Cement 

Gutta percha 

Porcelain 

Other 

Artificial dentures, cases handled . 
Dental X-ray: 

Complete examinations 

Partial examinations 

Interpretations 

Ward visits 



30 

1,217 

50 
286 

31 
11 
31 

3 

20 
13 

9 

417 

425 

190 

34 



OUT-PATIENT CLINICS. 



Total visits. 



New cases. 



Pay cases. 



Medical service 

Surgical service 

Eye, ear, nose and throat service . 

Physio-therapy service 

X-ray service 



11,040 

10,476 

5,763 

1,344 



1,998 
2,813 
2,664 
334 
1,087 



Total. 



38,291 



8,896 



1,612 

461 

783 

84 

396 



3,336 



VACCINATIONS. 

Number of adults vaccinated 45 

Number of "takes" 19 

Number of children vaccinated 7 

Number of "takes" 3 



BOARD OF HEALTH LABORATORY. 

(Operated in connection with Gorgas Hospital.) 
Dr. L. B. Bates, Chief of Laboratory. 

Bacillus typhosus. — Recovered in blood culture from 20 individuals 
and from stool specimens of 2 others. Of these 22 cases, 7 were from 
ships, 5 from Colon, 3 from the Canal Zone, 3 from New Cristobal, and 
4 from Panama. In addition B. paratyphosus B was recovered from 
stools of one patient from Panama, whose clinical course was also 
considered that of paratyphoid fever. 

Typhoid carriers. — On December 31, 1929 there was only one B. 
typhosus carrier, H. B., under sanitary surveillance. His stool speci- 
mens were examined at regular intervals but found positive for B. 
typhosus on two occasions only. On December 31, 1930, he was the 
only B. typhosus carrier under sanitary surveillance. 

Human trypanosomiasis. — On December 1, 1930, the Santo Tomas 
Hospital Laboratory staff found trypanosomes in a blood film from a 
patient in that hospital.' Both thick and thin films made on the 



'Santo Tomas Hospital is the national hospital of the Republic of Panama, located in the city 
of Panama. 



47 

following day also showed a fair number of the same trypanosome. 
The patient E. L. was an 18-months-old female mestizo child, which 
had been admitted on November 28, three days previously. The 
child also had a scalp infection, anemia and a rather heavy round worm 
infestation. Prolonged search of the blood films also showed a few 
estivoautumnal malarial parasites. The child was admitted to the 
hospital from its home, a thatched hut in the Chilibre region. It had 
at some time previously lived in Veraguas. The trypanosomes had 
the general morphology and staining characteristics of Trypanosoma 
cruzi, the trypanosome of Chagas' Disease. Extensive study of this 
case and of the trypanosome is now being made by the Santo Tomas 
Hospital staff and by the Gorgas Memorial Laboratory. This is the 
first case of human trypanosomiasis to be discovered or reported in the 
Republic of Panama or the Canal Zone so far as is known by the Board 
of Health Laboratory and for that reason is reported here. 

Sicklemia. — A death from sickle cell anemia diagnosed clinically and 
confirmed by autopsy occurred in Gorgas Hospital on April 19, 1930. 
(Autopsy protocol No. 8998.) The fact that this was the first death 
from sickle cell anemia to be reported in the Canal Zone stimulated an 
investigation into the incidence of sicklemia and latent and active cases 
of sickle cell anemia as determined by a study of the histological sec- 
tions of tissues obtained from autopsies performed in the Board of 
Health Laboratory from January 1, 1930, to December 31, 1930. 
During this period 375 autopsies were performed. Of these, 91 cases 
were white, 6 yellow (Chinese or Japanese), and 278 were black or 
mestizos. Because of advanced postmortem changes in drowned 
bodies, macerated stillbirths and other similar cases, microscopical 
studies were not made in 27 of the autopsies (8 white, 2 Japanese, 
and 17 black). 

No evidence of sicklemia could be found in any of the tissues from 
the white or yellow races. Of the 251 negro cases, in which histolog- 
ical preparations were available, 26 or 10.36 per cent had unmistak- 
able evidence of this abnormality in the formalin fixed specimens. In 
the microscopical examination of the spleen the follicles were small ; 
often many were completely atrophied. The fibrous trabeculae and 
the blood vessel walls were usually thickened, sometimes hyaline in 
appearance. The intertrabecular areas were reduced in width and 
marked by an intense engorgement of erythrocytes in both the venous 
channels and in the pulp cords. The cellular elements of the pulp were 
correspondingly reduced in amount. The majority of the follicles were 
surrounded by a zone of markedly increased engorgement, frequently 
in the form of small pools of sickle shaped erythrocytes. In the more 



48 

severe lesions the tissues surrounding the follicles were hemorrhagic in 
appearance. These changes with the marked characteristic deformity 
of the erythrocytes were found in all of the positive cases. Iron and 
calcium deposits occurred in only one case. 

Owing to the fact that many artefacts may occur in the erythrocytes 
as the result of postmortem changes, or during the fixation and prepara- 
tion of the tissues, all cases were discarded which though suggestive, 
did not have the characteristic abnormal structural changes in the 
spleen and marked anisocytosis with the typical deformity of the ery- 
throcytes. Eighteen cases having bizarre deformities of the erythrocy- 
tes, often with many sickle shaped cells, were rejected because either 
the structural changes in the spleen were absent or the erythrocytes 
lacked sufficient variation in size to be characteristic. Although 
several of the 26 positive cases had findings suggestive of active sickle 
cell anemia, all but three died of some other disease. 

There were three deaths from anemia during the year. One was 
diagnosed sickle cell anemia (Autopsy No. 8998), a second Von 
Jaksch's anemia (Autopsy No. 8954), and the third hemolytic ictero- 
anemia (Autopsy No. 9891). Reexamination of the latter two cases 
revealed the typical findings of a sickle cell anemia with no other lesions 
of sufficient importance to cause death. The records of these 
cases have therefore been changed to show the cause of death as sickle 
cell anemia (58b). 

The causes of death in the remaining 23 cases were reported as fol- 
lows: 

General paralysis of the insane 4 

Cardiac decompensation (nephritis, aortitis, etc.) 3 

Penumonia (lobar, broncho and unresolved) 3 

Pulmonary tuberculosis 2 

Peritonitis (strangulated hernia — perforated ulcer) 2 

Nephritis and uremia 2 

Typhoid fever 

Ruptured aortic aneurysm 

Tertiary syphilis (generalized syphilitic endarteritis) 

Arteriosclerosis (gangrene of foot, age 82) 

Subacute bacterial endocarditis 

.Acute myelitis (infected decubitus and celhilitis) 

Encephalomalacia 

The average age for all of the positive cases was 42 years. Two of 
the patients were less than one year old at the time of death. One 
died at 7 months and the other at 8 months. The oldest patient was 
82. The ages of the patients who died of sickle cell anemia were 8 
months, 2 years, and 51 years, respectively. Eighteen cases were male 
and 8 were female. Twelve cases were Jamaicans or of Jamaican 
parentage, 5 were Panamanians, 3 from Barbados, 3 from Martinique, 
1 from Guadeloupe, 1 from Nassau, and the nationality of 1 was not 
recorded. 



49 



The results of this investigation indicate that possibly some of the 
previously reported deaths from obscure forms of anemia may actually 
have been due to sickle cell anemia. 

Reports. — Approximately 54,897 reports not including duplicates 
have been made. 



BACTERIOLOGICAL PROTOZOAL AND MISCELLANEOUS EXAMINATIONS. 

Blood cultures 268 

Positive for B. typhosus 21 

Positive for Staphylococcus albus 7 

Positive for Staphylococcus aureus 6 

Positive for Staphylococcus aureus, hemolytic. 2 

Positive for B. coli 2 

Positive for Streptococcus hemolyticus ' 2 

Positive for Streptococcus viridans 16 

Positive for Streptococcus anhemolyticus 1 

Positive for Streptococcus (type undetermined) 2 

Positive for Staphylococcus aureus and Streptococcus anhemolyticus 1 

Stools cultured for typhoid dysentery group 1 , 605 

Positive for B. typhosus 25 

Positive for B. typhosus on carriers 1 

Positive for B. paratyphosus B 2 

Positive for B. dysenteriae Group II 68 

Positive for B. dysenteriae (type undetermined) 2 

Positive for Monilia psilosis 1 

Urines cultured for typhoid group 583 

Positive for B. typhosus 1 

Urines cultured for organisms other than typhoid group 407 

Positive for B. coli 71 

Positive for Staphylococcus aureus 1 

Positive for Staphylococcus albus 34 

Positive for B. pyocyaneus 2 

Positive for B. mucosus capsulatus 1 

Positive (orGram positive diplococcus 1 

Positive for Streptococcus anhemolyticus 3 

Throat cultures for B. diphtheriae 1 , 793 

Positive for B. diphtheriae 148 

Nasal cultures for B. diphtheriae 618 

Positive for B. diphtheriae ' 25 

Throat cultures for organisms other than B. diphtheriae 42 

Positive for Streptococcus 2 

Eye cultures 25 

Smear from external ear 1 

Positive for a yeast not yet classified 1 

Ear cultures 10 

Positive for a yeast not yet classified 1 

Mastoid cultures 2 

Nasopharyngeal cultures 88 

Sputum culturec 26 

Positive for Pneumococcus Type IV 1 

Positive for Saccharomyces 2 

Sputum cultures for fungi 3 

Spinal fluid cultures 91 

Positive for Meningococcus. 9 

Positive for B. influenzae 3 

Positive for Pneumococcus 1 

Positive for Streptococcus viridans 1 

Culture sterile but smear positive for B. tuberculosis 1 

Surgical tissues cultured 1 

Positive for Staphylococcus albus 1 

Pleural fluid cultures 47 

Kjiee fluid cultures 8 

Ascitic fluid cultures 3 

Cultures from skin lesions 32 

Culture of pus from various sources 20 

Autopsies cultured 42 

Organs, exudates, etc 54 

Culture of lung tumor (coughed) 1 

Positive for Monilia 1 

Bile cultures 9 

Positive for Aerogenes capsulatus 1 

Positive for Gram negative diplococcus 1 

Positive for Streptococcus (type undetermined) 1 

Milk cultiu-ed for bacterial count (dairy) 439 

Milk cultured for bacterial count (evaporated) 3 

Ice cream cultured for bacterial count 5 

MK 26916—4 



50 

Frezo cultured for bacterial count 4 

Darkfield examinations 53 

Positive for Treponema pallidum 2 

Conjunctival smears ' 51 

Positive for Gram negative intrarelluktr diplococci 15 

Positive for Gram negative bacilli resembling Koch-Week's baciUi 3 

Throat smears 112 

Positive for fusiform bacilli and spirilla of Vincent's angina 32 

Urethral smears 20 

Positive for Gram negative intracellular diplococci 10 

Smear from epididymis 1 

Smear from prostate 1 

Vaginal smears 59 

Positive for Gram negative intraceliular diplococci 24 

Sputum smears for B. tuberculosis '. 64 

Positive for B. tuberculosis 15 

Spinal fluid for B. tuberculosis '. 16 

Urine for B. tuberculosis 9 

• Examination of leper suspects 13 

Positive for B. leprae • 7 

Examination of lepers previous to parole 2 

Examination of paroled lepers 5 

Positive for B. leprae .' 1 

Autogenous vaccines prepared 45 

Feces examined for parasites and ova 100 

Positive for Entameba histolytica 5 

Positive ioT Entameba histolytica and embryos of Strongyloides stercoralis 1 

Positive for Uncinaria ova 2 

Positive for Taenia saginata (both segments and ova) 1 

Positive for Asraris lumbricoides 3 

Positive for Hymenolepis nana 1 

Positive for Tricli uris trichiura 2 

Positive for Stronjyloides larvae 3 

Urine for filiria (negative) 1 

Differential counts 55 

Red blood counts 3 

White blood counts 5 

Blood platelet count 5 

Reticulocyte count 4 

Hemoglobin estimations • 11 

Fragility test of blood 5 

Blood fUms examined for malarial parasites 1,052 

Positive for Tertian malarial pirasites '. 284 

Positive for£. A. malarial parasites 212 

Positive for Quartan malarial parasites 8 

Positive for Tertian and Quartan malarial parasites combined 4 ■ 

Positive for Tertian and E. A . malarial parasites combined 2 

Positive for Quartan andE. A. malarial parasites combined 2 ■ 

Blood smears for relapsing fever (negative) 2 

Water from Balboa Clubhouse swimming pool 300 

Water from Balboa Army and Navy Y. M. C. A. swimming pool 297 

Water from Pedro Miguel swimming pool 159 

Water from Union Club swimming pool 114 

Water from Fort Amador swimming pool 44 

Water from Fort Amador and Coast Defenses 123 

Water from Quarry Heights 2 

Water from Fort Sherman 2 

Water from Fort Clayton ; 2 

Water from U. S. S. Galveston 2 

Water from U. S. S. Pensacola 3 

Water from Las Minas Bay 1 

Water from New Gorgona 6 

Water from Taboga Springs Soda Water Company 1 

Water from Pina Guapa Island 1 

Water from rain barrel, Health Office, Panama 1 

Water and ice from Gorgas Hospital kitchen S 

Well water from the interior, R. de P 33 

VFeil water from Health Office, Panama 3 

Well water from Coca Cola Company 1 

River water from Puntarenas 1 

Dairy wash water from Gatun 1 

Drinking water from dairy, Health Office, Panama 1 

Drinking water from France Field 1 

Drinking water from Fort Sherman 1 

Foodstuffs examined: 

Cultures of bacon (Fort Clayton) 1 . 

Cultures of canned mushrooms (sterile) 3 

Cultures of canned sardines 1 

Cultures of oysters for typhoid-colon group /. . . 8 

Positive for B. coli 2 

Cultures of soda water 14 

Cultures of sugar for B. coli (negative) 1 

Ginger beer (Crown Bottling Works) positive for yeast 1 

Ice cream for food poisoning bacteria (negative) 1 



51 



SEROLOGICAL EXAMINATIONS. 

Wassermann tests 21,6 

Agglutination tests ] 

Positive with Proteus ( X-19) 1 

Positive with B. dysenteriae Group II (Flexner) 2 

Positive with B. typhosus 11 

Positive with B. paratyphosus A 1 

Positive forB. paratyphomsB 3 

Negative with B. meliiensis and B. abortus 3 

Blood typing for transfusion 

Examination of blood for coagulation time 



Analysis of Wassermann reactions. — Twenty-one thousand and 
eighteen Wassermann tests were performed on the blood of 14,875 
persons. The results are summarized below: 

TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE 
TO BOARD OF HEALTH LABORATORY ANp RESULTS OF TESTS, 1930. 



Race, sex, and status. 


Individuals 
positive. 


Individuals 
negative. 


Total 

individuals 

tested. 


Per cent of 

individuals 

positive. 


White, civU: 


243 

49 

2 


1,867 
676 

72 


2,110 

725 
74 


11 52 




6 76 


Children 


2 70 






Total 


294 


2,615 


2,909 


10 11 






White, military and naval: 


307 
41 


3,163 
304 


3,470 
345 


8 85 


Sailors, U. S. N 


11 88 






Total 


348 


3,467 


3,815 


9 12 






Black and mulattoes: 


1,192 
683 

28 


3,293 

2,566 

296 


4,485 

3,249 

324 


26 58 




21 02 




8 64 






Total 


1,903 


6,155 


8,058 


23 62 








12 


63 


75 


16 00 








2,557 


12,300 


14,857 


17 21 







In addition, Wessermann tests were made on 868 spinal fluids taken 
from 810 individuals. The results are summarized below: 

Individuals positive 116 

Individuals negative , 694 

Total iudividuals tested 810 

Per cent of individuals positive 14 .32 

PATHOLOGICAL EXAMINATIONS. 



Autopsies.- — Three hundred and seventy-five autopsies were per- 
formed at the Board of Health Laboratory. The causes of death were 
as follows: 



Epidemic, endemic, and infectious diseases: 

Typhoid fever 

Estivoautumnal malaria 

Influenzal pneumonia .._.._ 

Acute influenzal meningitis 

Acute bacillary dysentery (5. dysenteriae. 

Group II) 

Leprosy 

Erysipelas 

Acute bulbar poliomyelitis 

Meningococcus meningitis , 

Chickenpox 



Epidemic, endemic and infectious diseases — 
3 Continued: 

2 Pulmonary tuberculosis 

1 Disseminated miliary tuberculosis 

1 Tertiary syphilis 

Congenital syphilis 

1 Acute streptococcus cellulitis following 

3 vaccinia 

1 Epidermoid carcinoma of the tongue 

1 Carcinoma of the stomach 

4 Epidermoid carcinoma of the cervix uteri . 
1 Carcinoma of the breast 



37 
3 

27 
2 

1 
1 
5 
1 
1 



52 



123 



Epidemic, endemic, and infectious diseases- 
Continued: 

Epidermoid carcinoma of the neck 1 

Carcinoma of the adrenals 1 

Carcinoma of the pancreas 1 

Melanocarcinomatosis 1 

Carcinoma of the hypophysis 1 

Carcinoma of the larynx 1 

Gliosarcoma of the brain 1 

Rheumatic heart disease 4 

Pellagra 3 

Diabetes meilitus 4 

Splenic anemia 1 

Sickle cell anemia 3 

Acute myeloblastic leukemia 2 

Chronic splenorayelogenous leukenia 1 

Acute lymphatic leukenia 1 

Alcoholism, acute 1 

Total 

Diseases of the nervous system and of the organs 
of special sense: 

Chronic cerebrospinal meningitis 

Acute suppurative myelitis 

Cerebral hemorrhage 

Massive subdural hemorrhage 

General paralysis of the insane 

Glioma of the brain 

Acute hemorrhagic encephalitis 2 

Acute suppurative otitis media and mas- 
toiditis 1 

Acute suppurative mastoiditis 1 

Total 34 

Diseases of the circulatory system: 

Acute bacterial endocarditis 4 

Hypertensive heart disease '6 

Chronic myocarditis 6 

Cardiac hypertrophy and dilatation 1 

Arteriosclerotic heart disease 1 

Coronary sclerosis 5 

Generalized arteriosclerosis 2 

Multiple arteriosclerotic softenings of the 

brain 2 

Coronary thrombosis with occlusion of the 

right coronary artery 1 

Total 28 

Diseases of the respiratory system: 

Acute edema of the glottis 2 

Bronchopneumonia 8 

Lobar pneumonia 18 

Pneumothorax 1 

Lung at)scess 1 

Total 

Diseases of the digestive system: 

Agranulocytic angina 

Perforating ulcer of the duodenum 

Acute catarrhal enterocolitis 

Acute appendicitis 

Bilateral inguinal hernia 

Strangulated right femoraj hernia 

Strangulated intra-abdominal hernia 

Strangulated inguinal hernia 

Cirrhosis of the liver 

Abscess of the liver 

Chronic cholecystitis with occlusion of the 

cystic duct 

Chronic peritonitis 

Total 24 

Nonvenereal diseases of the genito-urinary 
system and adnexa: 

Acute hemorrhagic nephritis 1 

Chronic nephritis 25 

Chronic glomerulonephritis 1 

Pyclonephrosis 4 

Vesical calculus 1 



30 



Nonvenereal diseases of the genito-urinary 
system and adnexa — Continued: 

Periurethral abscess 

Prostatic abscess 

Hypertrophy of the prostate 

Multiple uterine myomata 

Total 

The puerperal state: 

Puerperal hemorrhage 

Accident of labor 

Total 

Diseases of the skin and the cellular tissue: 

Carbuncle of the upper lip 

Cellulitis of the external genitalia 

Inpetigo contagiosa 

Multiple infected decubital ulcers 

Total 

Diseases of the bones and organs of locomotion: 

Acute suppurative osteomyelitis, right 

tibia 

Total 

Malformations: 

Congenital internal hydrocephalus 

Congenital malformation of the heart 

Total 

Diseases of early infancy: 

Malnutrition 

Premature birth, nonviable fetus 

Accident of labor 

Injury at birth 

Septicemia neonatorum 

Total 

Affections produced by external <:auses: 

Suicide by sodium cyanide 

Suicide by poisoning (strychnine) 

Suicide by hanging 

Suicide by fircLirma 

Suicide by jumping from balcony. 

Acute novarsenobenzol poisoning 

Wood alcohol poisoning 

Accidental drowning 

Fall from boatswain's chair on mast of ship 

Accidental fall from ship 

Accidental fall from observation tower .... 

Traumatism by railroad 

Traumatism by automobile 

Traumatism by airplane accident 

Accidental traumatism by airplane crash . . 

Accidental homicide by firearms 

Killed in fight (fracture of skull) 

Intertrochanteric fracture of the right 

femur 

Infected wound in the scalp 

Asphyxia by vomiting 

Total 

Ill-defined diseases: 

Malnutrition 

Acute infection of undetermined origin .... 
Infection of undetermined origin 

Total 

Appendix: 

Stillbirth, accident of pregnancy 

Stillbirth, accident of labor 

Stillbirth, probably premature separation of 

the placenta 

Stillbirth, due to disease of mother 

Stillbirth, cause undetermined 

Total 



38 



53 



THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH 

LABORATORY, 1930. 



Cause of death. 





Per cent 




of 




autopsies. 


48 


12.80 


45 


12.00 


40 


10.66 


27 


7.20 


26 


6.93 


23 


6.13 


15 


4.00 


7 


1.86 



Syphilis (including 19 general paralysis) 

External causes 

Tuberculosis (acute and chronic) 

Bright's disease (acute and chronic nephritis) 

Pneumonia (broncho and lobar) 

Organic heart disease (acute and chronic) 

Cancer 

Cerebral hemorrhage 



THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH 
L.^BORATORY, 1904 TO 1930. 





S 






d 


"S ^ 






% 




■s 








» 






U 




.2 




m 




-S 




c'S 
















S 


-o 




c: . 




:g >• 


Year. 


II 


1 

a 

3 


J 

"a 

ja 
3 


O 3 


11 
« 

1^ 


1 

a 


■%& 

a a 
'Si % 
g-o 


2 

'S 
?? 


> 

'0 

1 


It 


03 


2. 2 
§ 2. 

:s g 




!z; 


Ph 


H 


W 


< 











H 





m 


1904 


6 
269 


1 

60 


1 
9 




















1905.... 


27 


3 


8 


5 


3 


9 




2 




1906... 


509 


191 


22 


50 


24 


23 


39 


15 


33 




2 




1907... 


496 


156 


35 


27 


40 


27 


36 


12 


58 


4 


4 


1 


1908... 


361 


59 


63 


46 


26 


25 


23 


11 


14 




7 


2 


1909... 


295 


55 


37 


26 


32 


31 


11 


17 


11 


1 


5 




1910... 


451 


50 


91 


52 


30 


37 


36 


16 


10 


6 


4 


1 


1911... 


508 


83 


102 


41 


38 


36 


19 


20 


9 


11 


11 




1912 ... 


425 


53 


79 


23 


37 


27 


15 


22 


6 


7 


11 


2 


1913... 


460 


47 


89 


21 


34 


26 


8 


26 


5 


23 


12 


11 


1914.... 


375 


36 


78 


6 


38 


12 


6 


27 


5 


14 


3 


5 


1915... 


328 


28 


56 


14 


20 


12 


5 


14 


2 


15 


10 


9 


1916... 


323 


25 


81 


8 


17 


20 


7 


10 


6 


9 


7 


15 


1917... 


330 


24 


51 


5 


21 


23 


3 


18 


1 


3 


5 


12 


1918.... 


253 


38 


68 


6 


6 


12 




8 




1 


5 


5 


1919... 


324 


22 


55 


3 


15 


14 


3 


20 


3 


10 


11 


8 


1920... 


334 
289 


•46 
14 


55 
37 


4' 


29 
16 


11 

5 


5 

8 


16 
17 






6 

7 


15 


1921... 


2 


4 


20 


1922... 


262 


14 


29 


5 


19 


9 


4 


9 


3 


6 


10 


14 


1923... 


205 


6 


17 


3 


9 


9 


5 


12 


2 


1 


11 


14 


1924... 


263 


14 


33 


3 


29 


10 


4 


21 


1 


3 


13 


12 


1925. ... 


306 


15 


34 


7 


38 


11 


3 


18 


1 


3 


16 


17 


1926.... 


282 


14 


32 


5 


32 


9 


2 


11 




5 


13 


25 


1927... 


358 


27 


22 


10 


35 


17 


3 


19 


2 


1 


21 


23 


1928... 


436 


45 


40 


8 


40 


20 


3 


13 


2 


10 


19 


46 


1929... 


453 


40 


44 


6 


48 


21 


5 


10 


4 


11 


23 


37 


1930... 


375 


26 


40 


2 


45 


26 


1 


23 


3 


1 


15 


48 


Total. 


9,276 


1,189 


1.300 


408 


721 


481 


259 


408 


192 


149 


253 


342 



' This includes 32 cases of influenza. 



54 



NUMBER OF AUTOPSIES PERFORMED REVEALING THE FOLLOWING DISEASES PER YEAR AT 
BOARD OF HEALTH LABORATORY, 1904 TO 1930. 


Year. 


S 
1 

3 °" - 


> 
1 


c 


.s 

1 
1 

>> 

c 
< 


B 


IB 

.S c 

-a g 

Ij 

•Si's 

c 


(2 


o 

"5 

E 


1904 


6 
269 
509 
496 
361 
295 
451 
508 
425 
460 
375 
328 
323 
330 
253 
324 
334 
289 
262 
205 
263 
306 
282 
358 
436 
453 
375 
















1905 


12 
1 

'2 

■2 

• 1 


7 
5 
1 

1 


7 
4 
2 
2 


2 




1 




1906 




1907 


1 
3 








1908 








1909 




'1 




1910 












1911 


1 


1 


1 
1 
3 
4 
2 


4' 

1 

2 
1 
3 
2 
3 
3 
1 
2 
3 


'1 




1912 




1913 




2 






1914 


-i 


1 

1 
2 
7 






1915 






1916 




1 


1917 


2 


1 




1918 






1919 


'2 








1920 -. . . 












1921 












2 


1922 








1 
1 




1923 












1924 








2 
3 

1 






1925 














1926....: 








1 






1927 












1928 














- 


1929 




1 




1 


5 

1 




1 


1930 


















Total 


9,276 


23 


27 


20 


22 


37 


3 


4 







All cases since 1906 were imported cases. 



' All cases since 1905 were imported cases. 



Per cent autopsied. — Five hundred and fifty bodies (not including 12 
for storage only and 3 disinterred) passed through the laboratory; 375 
or 68.18 per cent were autopsied. 



Malaria carriers found at autopsy. . . 
Syphilis found at autopsy (cases) . . . . 
Glycosuria found at autopsy (cases) . . 
Bacillary dysentery found at autopsy. 



Intestinal parasites found at autopsy. — Thirty-three cases in 375 
autopsies performed at the laboratory, or 8.80 per cent, showed one or 
more parasites or their ova, as follows: 



Ascaris. . . , 
Uncinaria . 



Trichuris 

Strongyloides . 



Multiple infections occurred as follows: 



Ascaris and uncinaria . 
Ascaris and trichuris. . 



Ascaris, uncinaria, and trichuris . 
Uncinaria and trichuris 



CAUSE OF DEATH FOUND AT AUTOPSY OF LEPERS IN BOARD OF HEALTH LABORATORY, 1930. 



Autopsy 
No. 



Cause of death. 



Contributory cause. 



9110 
9167 
9231 



Ijeprosy . 
Leprosy . 
Leprosy . 



Chronic nephritis. 
Pulmonary tuberculosis. 
None. 



55 

WILD AND DOMESTIC ANIMALS. 

Bacteriological: Autopsies: 

Blood smears from bull for Trypanosoma Dogs 2 

and Piroplasma (negative) 1 Guinea pigs 95 

Blood smear from dog 1 Rabbit* 56 

Blood smears from horses 20 White rats 1 

Positive for Piroplasina 2 

Negative for Trypanosomes Total 154 

and Piroplasma 18 

Blood smears from mules 8 Histological examinations: 

Cultures from autopsy material for B. Autopsy tissues from cows 93 

mallei (negative) 3 Positive for tuberculosis 65 

Culture from ears of cows for S. oniAracis. . 5 Blood from cow found dead in pasture ... . 1 

Culture of guinea pig spleens 95 Negative for B. anthracis .... 1 

Positive forS. paratyphosuiB. 45 Dog's head for rabies 1 

Culture of rabbit spleens 56 Negative for Negri bodies ... 1 

Positive for B. para/yp.'iosusB. 4 

Culture of white rat spleen 1 Total 95 

Culture from turkey for pathogenic 

organisms 1 Rats examined: 

Mus musculus 1 , 533 

Total 191 Mus alexandrinus 42 

Mus norwegicus 68 

Serological: Mxts rattut 1,219 

Complement fixation test for glanders on 



two animals (negative) 3 Total . 

Total 3 



MICROSCOPIC SLIDES PREPARED. 

Surgical tissue preparations (5 frozen) 2, 109 

Autopsy tissue preparations (2 frozen) 6,448 

Animal tissue preparations 292 

Total 8,849 

PHOTOGRAPHS. 

S. H., Gorgas Hospital No. 305,073— smallpox 3 

D. R., Gorgas Hospital No. 312,541 — fracture of right femur 2 

E. E., Gorgas Hospital No. 321,963— elephantiasis left leg , 5 

Total 10 

CHEMICAL ANALYSES .4ND EXAMINATIONS. 

Acid, hydrochloric 2 

Aleohol determinations 4 

Beverages 39 

Beer, alcohol determinations 3 

Rum, alcohol determinations 2 

Soda water for benzoic acid 6 

Positive for benzoic acid ■ 4 

Soda water for preservatives ■ 20 

Positive for saccharine 2 

Soda water for saccharine determinations 7 

Vermouth, alcohol determination 1 

Blood 2,686 

Nonprotein nitrogen determinations 2,261 

Urea nitrogen determinations 275 

Uric acid determinations 437 

Creatinin determinations 694 

Glucose determinations 2,549 

Calcium determinations 12 

Cholesterin determinations 1 

Carbon dioxide determinations 14 

Sodium chloride determinations : 9 

Carotin determinations 1 

Icterus index 99 

Van den Bergh tests 5 

Calibration — sphygmomanometer 11 

Chloride of lime 4 

Disinfectant "Ipersan" 1 

Drugs and chemicals 11 

Carbolic acid, crude 6 

Cattle dip, arsenical 4 

Atropin determination 1 

Dye stuff 1 

Feces, blood (1 positive) 2 



56 

Foodstuffs 454 

Butter 1 

Cream — fat determinations 3 

Ice cream 59 

Milk, dairy 379 

Milk, evaporated 2 

Milk, mother's 6 

Milk, sediment 1 

Nuts, cashew 1 

Oil, vegetable 1 

Sugar 1 

Gastric analyses 465 

Lime 

Manganese ore 

Manure, acidity 

Moth repcllant ^ 

Oil, "corozo" 

Polish, metal 

Rosin 

Soda solution, washing 

Spinal fluids ' 

Colloidal gold tests 842 

Globulin tests 841 

Glucose determinations 6 

Substances for identification 15 

Acetylsalicylic acid 1 

Atrophiue tablets 1 

Cocaine 6 

Cocaine hydrochloride 1 

Menthol crystals 1 

Mercuric chloride 1 

Nitroglycerine tablets 1 

Sodium cyanide solution 1 

Salicylic acid, solution of 2 

Toxicological 5 

Blood and urine (positive for ethyl alcohol) 1 

Brain, stomach and contents (positive for methyl alcohol) 1 

Stomach and contents (positive for alkali cyanide) 1 

Stomach and contents, urine, kidneys, brain and liver (stomach positive for strychnine) 1 

Stomach and intestines (negative for phosphorus) 1 

Urine. 106 

Bile pigment (positive) 1 

Glucose determinations 36 

Lead determinations (7 positive on 6 patients) 16 

Routine analyses 40 

Sugar determinations 1 

Uric acid determinations 2 

Veronal determinations 1 

Vomitus (positive for mercury) 1 

Water for chlorides 34 

Water, mineral analysis 1 

Acetone, recovered (liters) 84 

Alcohol, recovered (liters) 353 

Benzol, recovered (liters) 82 

Chaulmoogra esters prepared (liters) 20 

Dakin's solution prepared (liters) 326 

UNDERTAKING DEPARTMENT. 

Bodies received (3 disinterred) 565 

Bodies embalmed 85 

Bodies cremated 142 

Bodies buried on Isthmus 360 

Bodies shipped from Isthmus (3 disinterred) 64 



COLON HOSPITAL. 

(Capacity 130 patients.) 

Maj. H. P. Makel, Medical Corps, U. S. Army, Superintendent. 

Colon Hospital, during the year 1930, has functioned as a small gen- 
eral hospital, giving definitive treatment in all types of cases. Indi- 
viduals requiring special examinations and treatment, facilities for 
handling which were not available at the Colon Hospital, were trans- 



57 

ferred to Gorgas Hospital. At times, also, due to lack of bed space, 
it was found necessary to transfer other patients to Gorgas Hospital. 

Increase in the number of patients in Colon Hospital during the past 
two years has necessitated increases from time to time in the personnel. 
In 1928 the total personnel was 62; in 1929, 77; and in 1930, 84. 

There was a marked increase in the number of patients handled in 
both the dispensary and hospital. During the year the bed capacity 
was increased to 130 beds, 8 cribs, and 14 bassinets, making a total of 
152. This increase was made possible by continuing the policy of the 
previous year to secure bed space by making various alterations and 
improvements. The changes have greatly improved the general ap- 
pearance of the hospital, have furnished means of operating at greater 
efficiency, and have added materially to the general comfort of the 
patients. No detailed report of the changes will be submitted, but 
only a simple enumeration to give a general idea of what has been 
accomplished. 

I. Dispensary. — Painted throughout, rearrangement of offices, 
clinics, and waiting rooms. 

II. General. — (a) A new attractive front entrance, with handrails 
on front steps, was installed. 

(6) All offices have been consolidated into one main office. Three 
rooms at front of hospital were remodeled into one large room which is 
now the main office permitting quick and efficient handling of patients. 

(c) A clothing and baggage room was built for the hospital to facili- 
tate the safe handling of patients' clothing and baggage. 

{d) A new library was established by remodeling the old library 
room. In this library are now built-in shelves, comfortable chairs, and 
proper reading lights. An excellent selection of recent books was 
received. 

(e) Cold storage and kitchen: This important section has been re- 
modeled to meet existing needs. 

(/) Ambulance and garage: There was a thorough overhaul of am- 
bulances, bodies rebuilt and upkeep maintained! The Quarantine 
ambulance, now assigned to Colon Hospital, was given complete re- 
conditioning. 

(g) The grounds surrounding the hospital proper were landscaped, 
improving the outside appearance of the building. 

{h) At present, work is progressing in the repair of the exterior facing 
of the building of the hospital proper. This work should be completed 
during January, 1931. 



(i) Work of glassing-in the screened windows on the sea side open- 
ings along the stairways is in progress. This is necessary to keep rain 
and moisture off the concrete stairways, since the steps become very 
slippery at times and have caused several falls. 

III. Hospital. — Painted throughout. 

Ward A. — (1) Diet kitchen and bathroom were removed outside of 
ward to unused porch space. 

(2) A new linen room was built on unused porch space to provide 
place for safe-keeping of ward linen. 

(3) All permanent cubicles were renovated and running water in- 
stalled. 

(4) The surgical sections of ward were cubicled by curtains on nickel- 
plated rods. 

(5) A recovery room for seriously ill cases was established. 

(6) A nurses' office was arranged in the center of the ward, with 
running water and proper equipment to facilitate the nurses' work, and 
improve the efficiency of the ward work. 

Ward B. — (1) Diet kitchen and bathroom were removed outside of 
ward to unused porch space. 

(2) A new delivery room was' provided through alterations in avail- 
able space. 

(3) A permanent new nursery with proper equipment was arranged. 

(4) A new linen room was built on unused porch space. 

(5) A utility room was built on unused porch space. 

(6) All cubicles were renovated and running water installed. 

(7) A nurses' office was arranged in the center of ward with running 
water and proper equipment. 

(8) A childrens' section was established on land side porch; all cribs 
are separated in this section by small screens. Here these youngsters 
get their proper amount of sunshine and fresh air. 

Ward C. — (1) The sea side of this ward was completely furnished 
with windows and frame screens to shut out rain and winds. 

(2) The land side was furnished with frame screens. 

Ward E.— (I) By removal of wall sections this ward has now a capa- 
city of 36 beds divided into 3 units. 

(2) A nurses' office was arranged with running water and proper 
equipment. 

IV. The usual maintenance has been kept up on the nurses' quarters, 
storehouse, utility buildings, and morgue. To provide an extra room 
for the fifteenth nurse added to the staff this year, it was necessary to 
remodel a maid's room and install a private bath. All rooms of the 
nurses' quarters are now occupied. 



59 

The following new equipment was received during the year: 
16 beds for wards. 3 chairs invalid. 

50 chairs, ward. 1 stretcher, wheel. 

1 sterilizer, salt solution. 1 X-ray, bedside unit. 

45 recent medical books. 1 frame, Balkan, and other small 

1 ambulance from Quarantine Division. equipment for use in private 

rooms and wards. 

Personnd. — The full complement of personnel on permanent duty 
was as follows: 

Hospital. — 1 superintendent, 5 physicians, 15 nurses, 1 chief clerk, 
1 stenographer, 1 admitting clerk, 1 office helper, 1 laboratory techni- 
cian, 14 maids, and 15 orderlies. Dispensary. — 2 physicians, 1 pharma- 
cist, 1 assistant pharmacist, 1 maid, and 4 orderlies. Utilities and 
Supplies. — 1 storekeeper, 1 office helper, 2 helpers, 3 laborers, 2 carpen- 
ters, 1 painter, 3 ambulance drivers. Mess. — 1 cook, 1 assistant 
cook, 1 waiter, 1 assistant waiter, 2 kitchen helpers. Total, 29 gold 
employees and 54 silver employees. 

Movement of sick. — There were 91 patients in the hospital January 1, 
1930. There were 4,181 admissions during the year, with a total of 
41,150 patient days, making an average of 9.84 days spent in hospital 
per patient. There were 59,155 visits to the dispensary and 381 house 
and ship calls. 

Hospitalization. — The average number of beds occupied daily during 
each month of the year were as follows: 

January 103 July. 124 

February. 98 August 116 

March 1 1 1 September._ 1 10 

April 117 October 106 

May 111 November. 118 

June 117 December 116 

Medical service. — The increased number of beds in the hospital has 
resulted in the treatment of a greater number of patients than at any 
previous period since the construction of the new hospital plant. 

Malaria is the only tropical disease that still remains prevalent to 
any extent on the Atlantic end of the Canal Zone. This is due to the 
fact that people have been permitted to settle on the agricultural land 
of the Canal Zone, especially those bordering on Gatun Lake. Many 
of these farmers maintain temporary or permanent homes in Colon. 
There is thus a constant influx of infected persons and carriers into the 
community. This explains the occurrence of cases in persons who 
claim never to have been out of the sanitated area and even the city 
limits. A positive blood smear is required for the diagnosis of malaria. 

Amebic dysentery is practically nonexistent and the same is true of 
hookworm disease, although many instances of infestation with ankyl- 
ostoma is discovered by routine stool examinations. 



60 

A number of cases of typhoid have occurred in persons residing in 
Colon. Investigation has failed to discover the source of infection, 
probably some carrier. Water, milk, or food supplies have never been 
inculpated. 

Several times during the year there have been general endemics of 
influenza and upper respiratory infection. 

Of interest, recently, has been a small endemic of a disease simulat- 
ing scarlet fever. The cases are characterized by an initial chill, a rise 
of temperature to 102 or 103, pain in the back, acute posterior pharyn- 
gitis, followed on the second or third day by a general erythema, 
beginning at the neck, and spreading over the rest of the trunk. The 
eyelids are sometimes puffy and there are casts and albumin in the 
urine. In milder cases, only the posterior pharyngitis occurs. Most 
of the cases have been in adults, of short duration and no mortality. 

Among children, after bronchial affections, probably the most com- 
mon illness has been a condition which we have been diagnosing as 
acidosis. This begins with a sharp rise of temperature, sometimes to 
103 or 104, followed by vomiting and sometimes diarrhea, prostration, 
and acetone in the urine. These cases respond promptly to treatment 
by bowel irrigations, the administration of alkalies and carbohydrate 
feeding. At times these cases are so numerous, and occur so generally 
among all the social planes of the population, that it is felt we are deal- 
ing with an acute infectious disease rather than with a condition of 
disturbed metabolism of childhood. 

Among other interesting medical cases treated, may be mentioned 
a group of cases of acute glandular fever or acute infectious mononu- 
cleosis. A report of these cases was recently read at a meeting of the 
Medical Association of the Isthmian Canal Zone. 

As in the past years, the other usual types of medical conditions con- 
fronting the internist were encountered. 

Surgical service. — The surgical service showed a marked increase in 
work during the year. In addition to the usual amount of emergency 
surgery done, a considerable number of elective operations were per- 
formed. Emphasis was stressed on the pre-operative treatment and 
survey as well as on the post-operative care. 

Many cases of unusual interest were encountered. A brief sum- 
mary will be given of a few of the cases. 

Head cases were as numerous as previous year. This condition is 
due mainly to automobile accidents and to children falling from second- 
story balconies. The policy of conservatism was adhered to and only 
three cases came to operation. In two the outcome was excellent, in 
the other, fatal. 



61 

In one case of acute pancreatitis, the gall bladder and lesser peri- 
toneal cavity were drained with uneventful recovery. Later this 
soldier developed a lung abscess at the base of the lower right lung 
which did not respond to postural treatment but ruptured into the 
pleural cavity. The resultant empyema was treated by the closed 
method, i. e., trocar, cannula and catheter. This soldier has now been 
doing full duty for six months. Two other empyemas were treated 
with this method; both responded. 

A case of strangulated hernia, femoral, in an old colored woman of 
68 years, requiring a resection of six inches of small gut, made an un- 
eventful recovery. 

There were several cases of gun-shot wounds of the abdomen treated 
with good results. One case was struck by a .22 caliber bullet through 
the umbilicus, causing six perforations. These were sutured and 
recovery resulted. 

Two radical breast operations were performed for early carcinoma. 
Six months has past for one and nine months for another. To date 
both patients are apparently well and there is no evidence of recur- 
rence. 

The prevalence of tropical bubo or fourth venereal disease caused us 
to try treating these cases by protein shock therapy. Triple typhoid 
serum was given a thorough trial. This, however, proved disappoint- 
ing and operation had to be resorted to in the great majority of cases. 

Three cases of gas gangrene were encountered. All these cases 
received the gas gangrene antitoxin combined. Two, both early cases, 
responded, while the third, a late case, had a fatal outcome. 

Many carbuncles were seen and treated with actual cautery. While 
this method requires, often, secondary plastic procedures, it was 
found to be the safest procedure. Some carbuncles were transferred to 
Gorgas Hospital for deep X-ray therapy. 

Numerous plastic procedures, such as skin grafts, tendon sutures, 
osteotomy, tenotomies, etc., were done during the year. 

Skeletal traction was instituted in treatment of fractures of long 
bones. The results have been good and the handling of the case sim- 
plified. The number of fractures treated this year is greater than in 
previous years. 

An extra effort was expended on a more thorough and complete 
treatment of syphilis. The service conducted a clinic which showed 75 
per cent increase in treatments given over the previous year, in which 
year 100 per cent more treatments were given than in 1928. As a 
result of a thorough survey of patients, both in hospital and dispensary, 
a considerable number were found showing a positive serological 



62 

reaction. All cases were given a complete course of anti-leutic treat- 
ment, then followed up before any further treatment was given. 

On the surgical service, 521 major operations and 1,097 minor opera- 
tions were performed and 194 fractures were given definitive treatment. 
One thousand eight hundred and seventy-two treatments were given 
in the clinic for the treatment of syphilis. 

Obstetrical service. — The obstetrical service is a particularly active 
one, especially the colored section. It is becoming a more prevalent 
custom with the West Indian women to enter the hospital for delivery 
rather than be delivered at home by a midwife as in the past, and mid- 
wives refer all complicated cases to the hospital for treatment. 

In the white section, the number of deliveries has increased so that 
there has been an average of eight to twelve white women delivered 
each month. 

Among the white and colored cases, nearly every known complication 
has been encountered. Eclampsia is rather frequent at times among 
the colored, as is pernicious vomiting. 

Several interesting cases from a scientific viewpoint were met with. 
There were two cases of acrania, and one case of inherited deformity ol 
hands. 

Conservatism is preached and practiced in the handling of all ob- 
stetrical cases. All cases are seen, advised and treated during their 
pregnancy and followed for several months after delivery, in the clinics. 
At delivery no instruments or operative procedures are practiced until 
all conservative measures have been utilized and have failed. 

During the year there were 489 deliveries. Of this number 7 were 
stillbirths and there were 7 sets of twins. Nine patients were delivered 
by Cesarean section (1 Porro), 15 by forceps, 5 by Podalic version, and 
it was found necessary to do one craniotomy. 

X-ray department. — During the year 1,379 X-ray examinations were 
made, as follows: 

Hand, including digits 255 Shoulder 32 

Foot, including toes 158 Arm 32 

Dental.__ 143 Thigh _ 29 

Chest._ - 135 Hip.__ 21 

Wrist-_ .._ 120 Spine 19 

Leg 89 Mandible.__ 19 . 

Ankle. - 77 Pelvis 9 

Elbow - 61 Sacro-iliac joints 5 

Clavicle 44 Trunk, for foreign body „ 5 

Skull, including nose 40 Nasal, sinuses. 4 

Knee 42 Neck, for foreign body 3 

Forearm 36 Mastoid .— 1 

Total 1,367 



63 

Of the 1,379 examinations, 1,099 were original examinations on new 
patients. A large portion of the others were follow-up examinations 
made during the treatment of fractures. 

Of the 143 dental examinations, 28 were complete X-ray surveys. 

The equipment of this department consists of one Victor office unit 
and one Army bedside unit. The bedside unit was acquired on March 
12, 1930. This has proved a valuable addition to the equipment. Its 
chief use has been in the treatment of fractures that can not be moved, 
although it has been used in several bedridden cases of other types. 

Laboratory. — Only routine work is done by the laboratory of Colon 
Hospital. Serological culture and pathological work for the hospital 
are done by the Board of Health Laboratory at Ancon, C. Z. The fol- 
lowing routine work was done during 1930: 

Urines examined 15,350 Blood counts 4,075 

Stools examined _ 4,178 Malaria smears 3,870 

Sputums examined 382 Gastric analysis 28 

Other smears examined 299 Spinal fluids 17 

The term "other smears" comprises urethral, vaginal, cervical, 
throat, spinal, sediment from fluids, etc. 

The laboratory also collects blood for Wassermann and blood chem- 
istry from out-patients. The ward surgeons collect blood specimens 
from hospital cases. 

Specimens collected by the laboratory: Blood for Wassermann, 866; 
blood for chemistry, 25. 

Nursing staff. — The work of the staff of nurses in Colon Hospital has 
increased 50 per cent in the past two years, due to the increase in the 
number of patients treated. With the increase in surgery and obstet- 
rics more work has been demanded and received from the nurses. 
There have been only two additions to the nursing personnel. 

The staff consists of 15 American nurses, 2 of whom are always on 
leave, allowing 13 nurses for active duty during the year. The nature 
of duties performed are of a general character involving general medi- 
cine, general surgery, orthopedics, obstetrics, pediatrics, and the care 
of the newborn. 

The chief nurse has supervision of nurses and silver employees, is 
chief anaesthetist, is in charge of the operating room, is custodian of 
the linen, and housekeeper of the nurses' quarters. 

The operating room nurse is the suture nurse for the surgeon and is 
in charge of the delivery room (white) during the day. She keeps up 
sterile supplies, attends the surgeon's office during consultations, and 
is on call for emergency. The chief nurse acts as relief for emergency 
calls. 



64 

Recommendations. — The events of the past year have fully justified 
the past recommendation that Colon Hospital should be gradually 
enlarged to 250 beds and that the dispensary, although under the 
Superintendent of the Hospital, should function away from the hos- 
pital proper. The following figures are given for a 3-year period. 
Both hospital and dispensary show a substantial growth each year. 

Hospital. Dispens.vry. 

Year. Patient days. Year. Visits. 

1928._ 21.342 1928 42,138 

1929. 30,676 1929 47,110 

1930 41,150 1930 59,155 

The recommendation made last year that new quarters for the 
nurses be constructed, that the present nurses' quarters be converted 
into a dispensary, and that the present dispensary occupying the en- 
tire first floor of one of the wings of the hospital, be converted into a 
ward, was approved. The funds for construction and alterations will 
be available for expenditure on July 1, 1931, and with the completion 
of this work it is believed that facilities will be sufificient for about five 
years. 

COROZAL HOSPITAL. 

(Capacity, 615 patients.) 

Maj. S. L. Chappell, Medical Corps, U. S. Army, Superintendent. 

Purpose. — This institution cares for the insane of the Canal Zone 
and of the Republic of Panama, being reimbursed for the latter class 
of patients by the Republic at the fixed rate of $0.75 per day. It also 
cares for alien employees of the Canal Zone disabled by reason of 
injuries or chronic diseases who desire to enter the institution. 

Repairs and alterations. — The old guinea-pig pen was reconditioned. 
The concrete floor of the old structure had caved in and the building 
had become unsafe and useless. The shed was rebuilt at an approxi- 
mate cost of $185 by hospital forces under the supervision of the 
general mechanic. 

Two experimental compost pits were added during the year, one new 
and one remodeled, both along improved lines, by the sanitary gang 
under the supervision of Sanitary Inspector C. L. Pierce. These pits 
represent a departure from the type previously constructed and they 
allow for better composting of manure. 

Section "E" (building 525), used as a tubercular ward, was razed 
about August 1, 1930, by the forces of the Constructing Quartermaster, 
in order to provide a site for new male ward. 



65 

Grading was started on or about August 1 i, 1930, in connection with 
new 2-story male ward building, of concrete construction, estimated 
to cost $181,800. Actual pouring of concrete was commenced on 
December 2, 1930, and at the present time construction is progressing 
rapidly and satisfactorily. 

Routine painting and repairs to woodwork, plumbing, steam line, 
etc., have been made by hospital artisans, with the help of patients. 

On July 21, 1930, during the weekly moving picture show held for 
patients in the female dining hall, a fire occurred in the operator's booth. 
This was caused by operator throwing burning portion of film among 
other reels of film which were on the floor which in turn caught 
fire immediately. All windows in booth were promptly closed and 
patients were quickly removed from the building under the supervision 
of Dr. F. H. Dixon, who was present at the movies, and nurses and 
attendants. 

Both the fire department at Balboa and the fire department at the 
Post of Corozal responded to phone notification, and the Commanding 
Officer, Army station at Corozal, sent over a guard detail with assist- 
ants and attendants. 

Outside of a small abrasion received by the operator on the nose and 
left knee, there were no personal injuries sustained. The total prop- 
erty damage caused as a result of this fire was estimated at about 
$400, which consisted of loss of eight reels of film, cost of repairing 
moving-picture apparatus, replacing electric wiring, painting inner 
walls of booth. 

Following the fire improvements were made, installing automatic 
control of windows and purchase of a fire-proof film cabinet. The 
former operator was replaced by a new man and the latter warned 
not to leave any film about the room unless it is enclosed in a film 
cabinet or a metal container. The number of maids and attendants 
detailed for duty during moving picture shows has been increased 
and instructions have been issued and posted in moving picture hall, 
which, if observed, will reduce fire risk to a minimum. 

Insane patients. — The census on December 31, 1930, was 598, as 
compared with 608 at the end of the previous year. The number ad- 
mitted was 295 as compared with 269 for 1929. There were 240 dis- 
charges and 57 deaths. There were no suicides or deaths due to 
violence or altercations. Of the 240 discharged, 22 were considered 
as cured, 114 as improved, 97 as unimproved, and 7 were not treated; 
130 of the total released were repatriated. Twenty-one patients were 
transferred to Gorgas Hospital for treatment; 14 of these were returned 

MR 26916—5 



66 

to Corozal, 3 died, 1 was deported from there, and 3 remained in 
Gorgas Hospital at the end of the year. Of the total admissions, 140 
were cases paid for by the Government of Panama, and the remainder 
were Canal Zone charity cases or private pay patients. 

Other patients. — There were on December 31, 53 black and 6 white 
chronically ill or crippled inmates (not insane), as compared with 45 
black and 4 white of this class, including 2 out on pass, at the beginning 
of the year. Twenty-eight were admitted, 2 temporarily at Gorgas 
Hospital at the end of 1929 were returned, 1 died, and 8 were trans- 
ferred to insane status. Twenty-five of these patients were transferred 
to Gorgas Hospital for treatment, and of these 14 were returned to 
Corozal Hospital, 8 died while in Gorgas Hospital, and 3 remained 
under treatment at Gorgas Hospital at the end of the year. All those 
capable of performing work were encouraged to do so. Eighteen were 
carried on the payrolls, employed as broom and brush makers, bandage 
rollers, ward attendants, janitor, laborers, and helpers. The broom 
makers manufactured approximately 230 brooms per week. 

Recreation. — Weekly picture shows and band concerts have been 
continued, and the patients appear to derive considerable pleasure 
from these forms of entertainment. Picnics were held twice a month ; 
during the dry season in a grove back of the hospital, and during the 
rainy season in the basement of new ward building. Church services 
were held once a week for the Catholic and Protestant patients. The 
former are held in the chapel near entrance to hospital road, and the 
latter are conducted in the basement of the new ward building. 

Treatmejit. — Intensive specific treatment was given to patients suf- 
fering from syphilitic psychoses. Nine hundred and seventeen doses 
of arsphenamin were administered intravenously, and 381 lumbar 
punctures were made. At the end of the year there were 50 patients 
suffering from neuro-syphilis in some form; 35 of these were males 
and 15 females. 

Occupational therapy. — On December 31, 1930, there were 18 male 
and 30 female patients under treatment in the occupational therapy 
department. The men were taught carpentry, weaving, bag making, 
rush-work, etc.; the women were taught to make rugs and baskets, 
and to sew, knit, embroider, crochet and do rush-work. The articles 
produced and sold were: 160 rugs, 139 bags, 97 ornamental baskets, 
105 card-table covers, doilies and other embroidered pieces, 381 rafifia 
purses, 310 pieces of furniture, 8 boats in bottles, 16 knotted bags, 13 
pieces rush-work, and 30 pieces furniture painted and repaired. 

In addition to the patients engaged in various lines of work in the 
occupational ward, other male insane who were strong physically but 



67 

could not be accommodated in the occupational ward on account of 
limited space, were sent to the fields and employed in agricultural 
activities. The value of the produce taken from the patients' garden 
for hospital consumption amounted to $1,351.37. The more vigorous 
females were assigned to tasks in the laundry, sewing room, or in the 
salvage department. As a result of these various undertakings, 
between 75 and 80 per cent of the patients are engaged in some form 
of work. All of the laundering, with the exception of bed sheets, 
pillowcases, and nurses' uniforms, was done by the patients. 

The total sales from the occupational ward amounted to $1,865.45, 
and from the brooms and brushes manufactured by the "chronics," 
$4,645.85, a total of $6,511.30. This money is utilized for material 
required to continue activities in these departments, and for tobacco, 
confections, fruit, refreshments, etc., for the patients. 

Dairy and farm. — Repairs to fences were made, and pastures were 
cleared of brush during the dry season by cutting and burning. The 
pastures have always been a fire hazard at this hospital in the dry 
season. It is impossible to cut and burn all of them before they 
become dangerous. Each year a fire starts somewhere in the woods 
back of our farms and requires strenuous efforts to control it. Such a 
fire started in the fields during the early part of March, 1930. For- 
tunately attendants and workmen who turned out under direction of 
Dr. Dixon succeeded in stopping the flames before they endangered 
any buildings. Although most of this land is no longer needed for 
hospital purposes, it is essential for us to take care of the pastures to 
control this fire hazard. 

There were 26 cripples employed on the farm at the close of the year 
as compared with 27 at the beginning of the year. During this period 
3 were transferred to Gorgas Hospital for treatment, all of whom were 
returned; 1 was admitted, 1 was transferred to chronic ward, and 1 
was transferred to insane status. These men are employed in the 
garden, dairy, piggery, steam plant, cemetery, etc. Six are tending 
plots of land in the farm reservation, which they cultivate as gardens 
and are paid on an actual production basis. Their average earnings 
per month amounted to $57.35. Subsistence was furnished them free 
of charge. The receipts for produce sold aggregated $4,284.57, and 
for manure, $532.96. 

There were 115 pigs, 48 hogs, and 3 boars on hand December 31, 
1930. This section of the farm has been operating satisfactorily and 
produced net revenues during the year amouting to $1,093.61. 

As the dairy at Corozal Hospital was closed in December, 1930, it 
is deemed pertinent to review briefly the activities of the Health 



68 

Department in the production of milk from early construction days 
to the present time. 

Soon after taking over construction work from the French Company, 
the Isthmian Canal Commission decided that it would be advisable 
to establish a dairy farm for the purpose of providing fresh milk for 
the patients in the Ancon and other hospitals. 

A small herd consisting of 20 cows and 1 bull was purchased in the 
United States in October, 1906, and a dairy was established in connection 
with Ancon (now Gorgas) Hospital. Additional stock was purchased 
from time to time and production was increased gradually to such an 
extent that it was possible to supply fresh milk not only for patients 
in hospital but also for children and infants and at a later date a 
limited amount for all elements of the population. 

In 1915 the dairy was transferred to the Corozal Hospital reserva- 
tion, where a new barn, dairy, office, pasteurizing plant, and cold 
storage plant were erected at a cost of about $41,000. The records in- 
dicate that as milk producers the cattle imported from the United 
States would rapidly deteriorate as a result of adverse climatic con- 
ditions and diseases incident to the tropics. The purchase of replace- 
ments was necessary at frequent intervals. 

For a number of years after the dairy was established, the principal 
disease affecting the herd was an inflammatory condition of the uterus 
that evidently was infectious abortion. Periodic turberculin testing 
was begun in 1906 but not until 1916 was tuberculosis noted in the 
herd. During that year two positive reactors were noted and both 
were slaughtered. The herd became quite seriously affected with 
tuberculosis in 1919 (6 positive reactors), and since that time the 
disease has persisted from year to year. During the years 1922-1924, 
inclusive, the herd became quite extensively infected, 30 reactors hav- 
ing been discovered, of which 27 were slaughtered. This does not 
include animals giving suspicious reactions. The high rate of infection 
continued in 1925 and in 1926 an explosive outbreak occurred (15 
positive reactors). The Chief Health Officer designated a board to 
investigate the outbreak and drastic measures were taken to eradicate 
the disease. The board retested the herd, using a double check (intra- 
dermal and ophthalmic tests) and recommended immediate destruction 
of all animals showing either positive or suspicious reactions. Twenty- 
four animals were found to give such reactions and they were de- 
stroyed. 

In June, 1928, the herd was tested and 5 positive reactors and 2 
suspects were found. Four of these animals were destroyed. In 
February, 1929, a test of 131 animals showed 1 positive reactor and 



69 

in July, 5 positive reactors. These animals were all killed. In Feb- 
ruary, 1930, a test of 157 animals disclosed 9 positive reactors, and no 
suspicious ones; the 9 reactors were destroyed. 

On November 8, 1930, the entire herd was tested and 20 positive 
reactors and 20 reactors that were suspicious were noted. All animals 
showing positive reactions were shipped to Mount Hope immediately 
(November 11) and killed on November 12. All were autopsied and 
the carcasses run through vats for soap. All animals showing sus- 
picious reactions were isolated and a retest of entire herd was ordered 
with the provision that both the intradermal and ophthalmic tests 
would be used. The combined test was run on the entire herd on 
November 26, 1930, when 45 positive reactors and no suspects were 
found. 

These 45 positive reactors were shipped to Mount Hope on Decem- 
ber 10 and killed on December 11. Autopsy disclosed the fact that 
in 7 instances the lesions were extensive and the beef was considered 
unfit for human consumption; in 3 instances no lesions were observed; 
the remaining 35 showed slight lesions. 

Of the remaining stock of about 80 animals free of tuberculosis, 64 
were high-grade heifers. The evidence indicated that the infection 
had been spread through infected animals and infected pastures. In 
view of the value of the heifers (about $125 per head), the Chief 
Quartermaster was consulted and offered to take over these heifers 
provided they remained free of tuberculosis. This stock was immedi- 
ately transferred to the Atlantic side to prevent infection in infected 
pastures at Corozal, held in isolation and retested at frequent inter- 
vals. Only two animals gave a reaction, and they were immediately 
destroyed. 

The remaining animals at the dairy (about 25) mostly calves, were 
sold or slaughtered. 

The methods of testing animals for tuberculosis have conformed to 
those of recognized value throughout the world. In the early days, 
the subcutaneous method requiring subsequent observations of tem- 
perature, was used. This was eventually replaced by the ophthalmic 
disk method (eye test) which during recent years has been replaced in 
turn by the intradermal method. The intradermal method is now the 
accepted method for routine tests to be checked by the ophthalmic 
method when indicated. During recent years it has been the require- 
ment that the herd be tested twice a year, positive reactors to be de- 
stroyed, and suspicious reactors to be retested by both the ophthalmic 
and intradermic tests. 



70 



If viewed as a business venture, the dairy at Corozal has always been 
a losing proposition. The purchase of new stock and replacements of 
equipment should properly be carried as maintenance expense, rather 
than capital investment, and an analysis, for the past five years, of 
operating expenses (including maintenance charges as indicated above) 
and revenues, showed a deficit of approximately $14,000. This does 
not take into consideration the interest and depreciation charges on a 
capital investment of about $41,000 in dairy barns. Sale of stock on 
hand, and disposal of equipment on hand, reduced this deficit to about 
$6,000 or $7,000 for the 5-year period (about $1,300 a year). The 
establishment of a dairy by the Health Department and its operation 
up to the present time, even though at a loss of from $1,000 to $1,500 
a year, has been amply justified in that through this instrumentality 
milk of good quality, not otherwise available, has been made available 
for the sick, children, and others of the Canal Zone. During recent 
years, however, the Supply Department has developed a dairy indus- 
try, the dairy industry in Panama has been greatly expanded, and 
ample supplies of milk of good quality are now available. 

As the Health Department was operating the dairy at a loss that did 
not appear justified, a proposal was made to the Supply Department 
of The Panama Canal in June, 1930, that they purchase the Health 
Department dairy and consolidate it with the Mindi plant. Tentative 
plans were being made for the transfer when tuberculosis was discovered 
in the herd in November, 1930. This necessitated prompt action and 
the dairy was closed and the remainder of the herd transferred to the 
Supply Department of The Panama Canal. 

The following tabulation shows the commitments and discharges 
during 1930: 



COMMITMENTS. 





From Canal Zone. 


From Panama. 


Total. 




Male. 


Female. 


Male. 


Female. 






119 
6 


27 


56 
6 
3 
1 


67 
5 
3 


269 




17 






6 








1 








1 


1 






1 




1 












Total 


125 


28 


66 


76 


295 







DISCHARGES. 





Insane patients only. 


Male. 


Female. 


Total. 


Well . 


18 
79 
74 
5 


4 

35 
23 

2 


22 




114 




97 




7 








TotaJ 


176 


64 


240 







71 



PALO SECO LEPER COLONY. 

(Normal capacity 108 patients.) 
Dr. Ezra Hurwitz, Superintendent. 

The purpose of this institution is to afford domiciHary care and 
treatment to lepers from the Canal Zone and the Republic of Panama. 
At the beginning of the year 97 patients were being cared for. 

Nine new patients were admitted, 2 were readmitted, 4 were dis- 
charged, and 5 died. The patient census at the close of the year was 99. 

Deaths. — The immediate causes of the deaths are shown in the follow- 
ing table: 





Age. 


Sex. 


J. L 


59 


Male. . 


J.G 


61 


Male. . 


S. C 


75 


Female. . . 


F.G 


27 


Male. . 


D.P 


36 


Female. . . 



Admitted. 

April 5, 1918 

July 15, 1921 

September 27, 1915 

May 1, 1928 

March 21, 1929.... 



Died. 



Immediate cause of death. 



July 16, 1930 

September 18, 1930. 
October 21, 1930... 
November 12, 1930. 
December 1, 1930... 



Chronic nephritis. 

Pulmonary tuberculosis. 

Leprosy. 

Pulmonary tuberculosis. 

Pulmonary tuberculosis. 



Three of the above cases were autopsied at the Board of Health 
laboratory and, in accordance with the preference of the Manual of 
Joint Causes of Death, 2d edition, 1925, of the Bureau of the Cen- 
sus, the cause of death was recorded as leprosy in all three cases (see 
report of Board of Health Laboratory, page 46). 

Discharges. — Two patients were discharged for repatriation to their 
homeland. Both were bacteriologically positive for mycobacillus 
leprae. 

Two patients were paroled. They met all requirements for parole, 
and leprosy in each case was considered arrested. 

Readmissions. — One patient (still an arrested case) was readmitted 
at his own request, not having been able to adapt himself to conditions 
outside of the colony; and one was readmitted because of relapse into 
positive leprosy. 

Treatment. — Semiweekly intramuscular administration of ethyl esters 
of chaulmoogric acids continued to be the routine treatment in all cases. 
No experimental work was attempted. Acute conditions and con- 
comitant diseases were treated as they occurred. Dental treatment 
was limited to extraction of carious teeth. 

During the year, 59 patients were employed by the colony and were 
paid $3,897.72. Eighteen patient-farmers sold $460.74 worth of pro- 
visions to the colony mess. One thousand three hundred and fifty- 
four dollars were distributed to the patients in monthly gratuity allot- 
ments. On December 19, Archbishop Rojas y Arietas, of Panama, 
visited the colony and gave each patient one-half dollar. Father Gay 



72 



gave each patient some articles of wearing apparel or dress goods at 
Christmas. Other gifts were received by the patients from other 
sources. On December 30, Bishop J. Craik Morris gave the patients 
a banquet at which, in the bishop's absence, Rev. Halsey Werlein 
acted in his stead. 

DISPENSARY SERVICE. 

The Health Department maintains well-equipped dispensaries (out- 
patient clinics) in all of the larger permanent towns located in the Canal 
Zone for the treatment of Government employees with minor ailments 
of a medical or surgical nature, and for handling emergency work. 
Each dispensary furnishes an ambulance service. The dispensaries 
are five in number, located as follows: Two at the Pacific terminal of 
the Canal, one for the Ancon district and one for the Balboa-La Boca 
district; one at Pedro Miguel, which cares for the populations of Pedro 
Miguel, Paraiso, and Gamboa; one for the Gatun District; and one at 
the Atlantic terminal (Cristobal -Colon), which is administered in con- 
nection with Colon Hospital. 

The staffs of these dispensaries consists of from one to three 
physicians, one dispensary assistant (pharmacist), and the necessary 
quota of attendants, chaufifeurs, clerk, etc. The type of building used 
for this purpose is shown in the photograph on the following page. 

In addition, one or more district dentists are assigned to each district, 
to cover the dental work for their district; these dentists receive no 
pay, but in exchange for privileges granted them — rental of quarters, 
reduced rates on railroad and steamship line and permission to purchase 
at the commissaries — are required to do dental work for employees and 
their families at rates scheduled by the Governor. 

The volume of medical work done by the various dispensaries is 
shown in the following Table 27. 

TABLE 27.— REPORT OF DISPENSARIES. 

EMPLOTEES TREATED IN QUARTERS. 



DispenBary. 


Remaining 

January 1, 

1930. 


-Admitted. 


Died. 


Discharged. 


Transferred. 


Remaining 
December 
31, 1930. • 




White. 


Black. 


White. 


Black. 


White. 


Black. 


White 


Black. 


White. 


Black. 


White.' Black. 




2 
1 


8 
2 


709 
1,178 
177 
125 
448 


1,158 
743 
171 
159 
978 






690 
1.178 
177 
126 
439 


1,085 
740 
171 
159 
974 


18 


74 


3 7 


Balboa 






1 5 
















1 
1 


"22' 
















1 






10 25 










Total........ 


5 


32 


2,637 


3,209 




1 


2,610 


3,129 


18 


74 


14 37 



73 



TABLE 27. -REPORT OF DISPENSARIES— Continued. 

BUPLOTEES TREATED IN QUARTERS 



Dispensary furnishing treatment. 


Days treatment furbished. 


Average number treated 
in quarters per day. 




White. 


Black. 


Total. 


White. 


Black. 


Total. 




1,789 

1,909 

422 

344 

1,550 


4,744 

2,138 

524 

789 

8,418 


6,533 
4,047 
946 
1,133 
9,968 


4.90 
5.23 
1.16 
.94 
4.25 


13.00 
5.86 
1.43 
2.16 

23.06 


17.90 


Balboa 


11.09 




2.59 




3 10 




27.31 






Total 


6,014 


16,613 


22,627 


16.48 


45.51. 


61.99 







ALL CASES TREATED BUT NOT EXCUSED FROM WORK. 



Dispensary. 


Employees. 


Nonemployees. 


Total. 


White. 


Black. 


Total. 


White. 


Black. 


Total. 


White 


Black. 


Total. 




6,612 
12,990 
3,083 
3,474 
6,919 


20,077 

13,865 

8,695 

7,225 

17,732 


26,689 
26,855 
11,778 
10,699 
24,651 


6,495 
13,291 
6,599 
4,272 
11,347 


17,765 
12,651 
15,744 
8,003 
23,069 


24,260 
25,942 
22,343 
12,275 
34,416 


13,107 

26,281 

9,682 

7,746 

18,266 


37,842 
26,516 
24,439 
15,228 
40,801 


50,949 


Balboa 


52,797 




34,121 




22,974 


Colon 


59,067 






Total 


33,078 


67,594 


100,672 


42,004 


77,232 


119,236 


75,082 


144,826 


219,908 









DIVISION OF SANITATION. 

Organization and activities. — This division concerns itself with all 
measures relating to the control and prevention of communicable 
diseases, more particularly hose transmitted by insects — malaria, 
yellow fever, plague, etc. Its operations are carried on under the im- 
mediate direction of the Assistant Chief Health Officer. The most 
important single activity undertaken is that of prevention of malaria 
which is accomplished principally through the elimination of breeding 
places of malaria carrying mosquitoes. Other important activities 
are: The elimination of breeding places of annoying mosquitoes in 
general in permanently settled towns and in their .vicinity; the preven- 
tion of breeding of flies — principally the house fly (Musca domestica), 
the biting stable fly {Stomoxys calcitrans), and the various flesh flies 
and blow. flies; the prevention of the breeding of rats; supervision — 
from the viewpoint of the public health — of the distribution of milk, 
meat and other foods, of water supplies, and of the disposal of human 
and other wastes. The division also is charged with the investigation 
of cases and outbreaks of acute exanthematous diseases and the initia- 
tion of measures having in view the prevention and control of epidemics. 

The division also concerns itself with the investigation of diseases 
affecting domestic animals and the institution of measures for their 
control. 

The activities referred to above are carried out in the Canal Zone 
and in the areas adjacent to the terminal cities by the organization 



74 

charged with field sanitation, and in the terminal cities, Panama and 
Colon, by health organizations maintained in those cities by the Health 
Department of The Panama Canal at its own expense. 

In connection with malaria control work in the Canal Zone, it should 
be understood that while the major part of this work is done by the 
Health Department of The Panama Canal, the Army maintains an 
organization for malaria control operations on Army reservations and 
in the vicinity of Army stations. Approximately $40,000 is expended 
annually by the Medical Department of the Army for this purpose. 

The geographical areas allotted to the two field organizations (Health 
Department of The Panama Canal and Medical Department of the 
Army) are definitely prescribed by mutual agreement between the Chief 
Health Officer of The Panama Canal and the Chief Surgeon of the 
Panama Canal Department of the Army. 

For purposes of supervision of field sanitation, the Canal Zone is 
divided into districts, the work in each district being under the direction 
of an American inspector with the necessary number of colored foremen, 
larva hunters, ditching gangs, oiling gangs, maintenance gangs and other 
laborers. Altogether the force engaged in work of this nature numbers 
5 inspectors and approximately 120 colored employees. 

The Northern District extends from north of Darien Radio Station 
to the Atlantic entrance of the Canal, with headquarters at Gatun 
The Southern Division, extending from the Darien Radio Station south 
to the Pacific terminus of the Canal and including the outskirts of the 
city of Panama, is divided into three districts, Ancon-Balboa, Panama 
Suburban (in the Republic of Panama), and Pedro Miguel. The oper- 
ations of the Southern Division as a whole are supervised by a division 
inspector with administrative inspectors assigned to each district. The 
Southern Division has an office building at Ancon which serves also as 
headquarters for the three districts. The Health Department has a 
tile manufacturing plant which is operated by the Southern Division. 
A description of the plant, the types of sections manufactured for 
drainage purposes, and the condition under which the various types 
of sections are laid for purposes of drainage, was published in "Twenty- 
Five Years of American Medical Activity on the Isthmus of Panama," 
in 1929. 

In malaria control work on the Isthmus, principal reliance is placed 
on the installation of permanent drainage works in areas that consti- 
tute actual or potential breeding places for mosquitoes. The particular 
type of drainage adopted depends on the terrain to be drained and the 
object to be accomplished. In some localities subsoil drains serve the 
purpose, in others open ditches with hemicylindrical concrete bottoms, 



75 

or ditches with concrete bottoms and concrete side slabs to protect the 
banks; in still other localities reliance is placed on open earth ditches 
and the training of streams. In some localities subsoil drains with 
superimposed hemicylindrical concrete-bottomed drains are used. The 
methods of drainage and conditions under which various types of 
drainage are adopted are described in previous annual reports (see 
Annual Reports: 1927, page 18; 1925, pages 18-19). 

Subsoil drainage is used when practicable, as it has proven to be very 
satisfactory and there are practically no maintenance charges. Open 
ditches with concrete bottoms, if properly constructed to grade, are 
quite efficient and maintenance charges are low. Areas in which drains 
are installed are patrolled by maintenance gangs at periodic intervals 
and kept in serviceable condition. 

On completion of the Canal, when definite decision had been reached 
as to the location of permanent settlements, the policy was adopted of 
installing permanent drainage works in the immediate vicinity of such 
settlements with extensions to adjacent areas as the necessity for such 
extensions became evident and available funds permitted. This type 
of malaria control work has been continued from year to year and the 
areas now under control are as indicated on maps published in the 
annual report of the Health Department for the year 1928. 

No extensive new drainage projects were undertaken during 1929 or 
1930, efforts having been concentrated on the perfection of those 
already completed. 

In some mosquito-breeding areas drainage is not practicable, for 
example, the Miraflores lakes. During part of the construction 
period and for a few years thereafter, it was the custom to control breed- 
ing in such areas by the application of fuel oil diluted with so-called 
"larvicide" to the surface of the water. This latter preparation be- 
came known as the Panama Canal larvicide; the method of its 
preparation is as follows: 150 gallons of crude carbolic acid is brought 
to the boiling point in a steam kettle; 200 pounds of crushed rosin is 
added, agitating occasionally; 30 pounds of caustic soda is dissolved in 
6 gallons of water and added to the acid and rosin, and the whole boiled 
about 30 minutes. 

Crude oil is available throughout the Canal Zone and costs con- 
siderably less (at present 90 cents per barrel of 42 gallons) than the 
special larvicide. It has been found that by heating the oil to about 
70° C. its passage through the nozzles of knapsack sprayers and pump 
sprayers on boats is facilitated. It forms a very satisfactory film on 
the water. It has replaced the larvicide mixture and has been used 
generally for a number of years. 



76 

The screening of houses occupied by human beings has been found to 
be a very effective malaria control measure and is practiced in all resi- 
dential areas for employees maintained by The Panama Canal. 

The Assistant Chief Health Officer and his assistants are constantly 
studying the insect life of the Isthmus, more particularly the life habits 
and biological characters of the known and possible disease transmitting 
species of mosquitoes. Through the development and simplification 
of identification technique, new species are being identified and de- 
scribed from time to time and the knowledge being gained of the life 
habits of the groups of mosquitoes indigenous to the Isthmus is being 
applied practically in the mosquito control work. 

A considerable amount of time and effort is devoted to the control of 
fly breeding, especially breeding of the house fly (Musca domestica) , 
the biting stable fly {Stomoxys calcitrans), and the various flesh flies 
and blow flies. Observations on the Isthmus extending over a period 
of many years indicate that the house fly and stable fly, though breed- 
ing throughout the year, are of seasonal occurrence, the season of most 
prolific breeding being in April, May, and June (beginning of the season 
of rains). The general statement is warranted that the Canal Zone 
and the two terminal cities are singularly free of flies. It is known that 
in tropical countries flies have many more natural enemies (ants, 
spiders, etc.) than is the case in temperate climates, but it has been 
demonstrated repeatedly on the Isthmus that if suitable breeding 
conditions exist and continue to be available, flies multiply very rapidly 
and soon become a pest. 

In the Canal Zone it is essential that provision be made for raising 
fresh vegetables. The soil is not rich, leaches rapidly, and must be 
repeatedly fertilized. Manure is the least expensive fertilizing ma- 
terial available but it also is the most attractive substance known for 
the breeding of house and stable flies. Recognizing the importance of 
the conservation of manure for fertilizing purposes, the Health Depart- 
ment for many years has carried out experiments in composting 
manure which have had in view the reduction of fly breeding to the 
lowest possible minimum. 

The procedure now followed, which gives satisfactory results if con- 
stantly supervised by competent personnel, is as follows: Manure is^ 
collected daily and placed in concrete pits which, when filled, are closed 
tightly to prevent air gaining access and to prevent fly larvae from 
crawling out. The sealing of the pit and bacterial action resulting in 
decomposition of the manure produce a temperature ranging from 30° 
C. to 53° C, which kills practically all the larvae. The pit remains 
sealed for a minimum period of 17 days (the maximum life cycle from: 



■77 

egg to adult for these flies) subsequent to which time the manure is 
made available for use as fertilizer. The manure so treated still is 
attractive to flies, though not so much so as is fresh manure. To pre- 
vent further breeding, the regulations provide that all manure used 
for fertilizing purposes must be spread in thin layers (not to exceed 
one inch) or spaded into the ground within 24 hours after arrival at the 
garden. In addition, when manure is issued to gardeners, the district 
sanitary inspector concerned is immediately notified and the garden is 
inspected to see that the regulations are being complied with. 

Fly breeding at the garbage disposal dumps is prevented by covering 
with a 6-inch layer of damp earth, tamping it down and inspecting 
constantly for larvae that may crawl out or for recently emerged flies 
that may make their way to the surface. The few flies and larvae ob- 
served are killed with a spray consisting of 8 parts crude oil, 1 part of 
creosote, and 1 part of kerosene. 

The regulations governing construction, alteration, and repair of 
buildings in the Canal Zone and in Panama and Colon contain adequate 
provisions for rat-proofing. It is the responsibility of the division of 
field sanitation, through its inspection service, to see that these regula- 
tions are adhered to. 



ROUTINE AND SPECIAL ACTIVITIES UNDERTAKEN DURING 1930. 

Routine activities. — All routine control work, including maintenance 
of drainage projects and oiling, was carried out in all the areas under 
control. As is usual, near the end of the dry season all drainage sys- 
tems were inspected, necessary repairs made, obstructions removed, 
bottoms brought to grade, and stream beds straightened out and 
trained. 

Special projects undertaken during 1930. Preliminary investigation 
of malaria in the Madden Dam area. — Work is to be begun on the con- 
struction of the Madden Dam in 1931. As this project will require 
about five years to complete and a thousand or more laborers will be 
engaged on the work for several years, special studies have been made 
and will be continued of the malaria situation in the populations of the 
villages on the Chagres River in the neighborhood of the dam site. 
This work is being done in cooperation with the director and technical 
staff of the Gorgas Memorial Institute. This institute has been mak- 
ing monthly surveys of the blood of the inhabitants of the nearby 
villages, to determine the percentage of malaria existing in these popu- 
lations at various seasons of the year. In the near future the institute 
will employ a public health nurse to visit periodically all malaria in- 



78 

fected individuals and administer quinine for curative purposes. The 
effect of this treatment on the occurrence of malaria in the populations 
will be carefully followed and checked by surveys. 

Malaria surveys of construction gangs and treatment of carriers. — In 
July, 1930, the policy was adopted of making monthly surveys of all 
gangs of laborers engaged in construction projects beyond the sanitated 
areas and treating those showing parasites in the blood. The object 
in view is twofold ; to cure as many individuals as possible, thus reducing 
to some extent the possibility of the transmission of the malarial para- 
sites from infected persons to mosquitoes ; and to prevent the occurrence 
of clinical malaria in individuals who are carriers of the malarial para- 
site without symptoms, thus reducing hospitalization and labor turn- 
over. This periodic survey work with treatment will be continued. 

Identification of new species of mosquitoes. — Constant study is made 
of the mosquitoes of the region, the inspectors engaged in mosquito 
control work being equipped with excellent microscopes and accessories 
for this work. During the year a new species of Anopheles of the 
Arribalzagaia group, A. neomacidi palpus Curry, was discovered in the 
Canal Zone.' Although breeding abundantly at times in wet pasture 
lands, it is apparently not important as a malaria carrier. It breeds 
readily in water foul with cattle droppings, and in the sunlight. 
Another one recently discovered is possibly Anopheles oswaldoi 
Peryassu, which too seems not important as a malaria carrier. It 
breeds only in densely shaded jungle pools and is considered by some 
to be a variety of A. tarsimaculatus Goeldi. A more important find is 
that of A. albitarsis Lynch Arribalzaga, which was found breeding in 
remote parts of Gatun Lake. The larvae were chiefiy in surface 
patches of bladderwort ( Utricularia mixta) in which they find food 
and shelter from their enemies. This is believed to the farthest 
north range of this species yet determined. It is undoubtedly a 
dangerous carrier of malaria. 

Trypanosomiasis in a?iimals. — From time to time since the construc- 
tion of the Canal under American auspices was undertaken, the herds 
of horses and mules in the Canal Zone have been affected with a highly 
fatal type of trypanosomiasis (a protozoal disease) known as "murrina." 
The disease is brought in from the Republic of Panama. The anala- 
gous disease in man is the sleeping sickness of Africa and in animals in 
the Philippine Islands and elsewhere it is known as "surra." In Jan- 
uary, 1930, murrina appeared in a breeding herd of the cattle industry 
located on the west side of the Canal opposite Miraflores. Under the 
direction of Dr. H. C. Clark, Director of the Gorgas Memorial Insti- 

'Described in .American Journal of Hygiene, XIII, 2 pp. 643-647, March, 1931. 



79 

tute, and with cooperation on the part of the Health Department and 
the Supply Department of The Panama Canal, and the veterinary 
authorities of the Army, a survey was made of all mules and horses in 
the Zone. At that time the disease was found to be confined to the 
herd at Miraflores. Quarantine measures were put into effect and 
infected animals were either killed or isolated and treated. A resurvey 
about six months later showed that trypanosomiasis had gained a foot- 
hold in horses and mules on the west side of the Canal in the vicinity 
of Gatun Dam. As the Army has more than a thousand valuable 
animals in that area, on the east side of the Canal, it was necessary to 
act promptly and drastically. All infected and exposed animals 
belonging to The Panama Canal were immediately destroyed and all 
infected animals the private property of individuals were immediately 
destroyed. Resurveys have been made periodically and newly in- 
fected animals destroyed or isolated. The method of spread of the 
disease is not known, probably by a fly. The Gorgas Memorial Insti- 
tute is investigating a number of phases of this problem and already 
has collected much scientific information contributory to our knowledge 
of this disease from the viewpoints of diagnosis, immunity, and methods 
of control. 

Experiments in composting manure. — For a number of years the raw 
manure accumulating in the Canal Zone has been collected daily, placed 
in large concrete pits, and sealed tightly for a definite period of time. 
While in the closed pit, bacterial action is active and chemical changes 
occur, presumably somewhat analagous to those observed in silos. 
The manure when placed in these pits is already grossly infested with 
eggs of the house fiy and stable fly. The heat and gases generated in 
the pits kill the fly larvae which hatch from the eggs, and some 
chemical changes occur in the manure which apparently render it less 
attractive to the adult female fly, but not markedly so. It was felt 
that possibly the principle involved in the Beccari system of garbage 
disposal as used in Florence, Italy, might be applied to the disposal 
of manure in the Canal Zone with a resulting humus that would not 
attract flies. 

Part of that system, namely, placing the manure in pits that are 
tightly sealed for a definite period of time had been a routine procedure 
in the Canal Zone for a number of years. The second step of the pro- 
cedure namely, to allow fresh air to circulate freely throughout the 
mass of manure permitting bacterial action by aerobic bacteria, was 
easily arranged by the construction of racks on which the manure could 
be deposited and by the installation of ventilators at the bottom and 
top of the pit. 



80 

Two concrete pits were arranged in this manner and experiments 
are under way. The procedure so far has been to seal the pit for a 
period of 7 days and then ventilate for from about 30 to 40 days. So 
far, no results of any great practical value have been obtained. The 
problem is a somewhat complicated one as the composition of the 
manure from Panama City differs quite materially from that from 
Army stations, and experimental conditions during the dry season are 
very different, so far as moisture content is concerned, from those 
existing during the season of rains. Experiments carried out so far 
suggest that the odor of the treated manure differs materially from 
that of fresh manure, that the resulting humus is but slightly attractive 
to house flies but has lost none of its attraction for stable flies, that 
decomposition is more advanced than in the case of manure held in 
sealed pits for 17 days, and that treated manure which has become 
grossly infected with one of the white moulds common to this region 
does not attract house flies and can be used as fertilizer with com- 
paratively little danger of reinfestation with house flies. 

Disposal of garbage, Pacific entrance to the Canal. — For several years 
the garbage collected from the communities located at the Pacific en- 
trance to the Canal, Ancon, Balboa, La Boca, Fort Amador, Quarry 
Heights, and Panama City, has been disposed of at a garbage dump 
located in a low marshy area in the Calidona section of Panama City. 
The method in use is "fill and cover," the advancing face of the dump 
being about 15 feet high before settling takes place. The top and 
sides are covered with about six inches of wet earth. Fly breeding is 
prevented in large degree by the spontaneous development of a high 
temperature and noxious gases in the decomposing material. The few 
larvae which survive and make their way to the surface and adults that 
emerge are destroyed by the -application of a spray consisting of 8 parts 
crude oil, 1 part creosote, and 1 part kerosene. A high grade residential 
section is gradually being developed east of the present dumping area 
and new streets are being laid and residences constructed within ap- 
proximately 500 yards of the foot of the dump. The present dumping 
area must be abandoned in the near future and extensive studies of 
the problem are being made by the Health Department. This study 
will be completed and a new system of disposal adopted in 1931. 

Special projects undertaken in the northern district. — Special attention 
has been given to the malaria situation in Gatun (Atlantic side) and 
its vicinity. The malaria rates in the vicinity of Gatun Dam have 
been greater than the average on the Zone for a number of years. 
This statement applies in general to the Canal Zone town of Gatun, 
to Fort Davis — a large Army station on the flats north of Gatun Dam 



81 

— and to Fort Sherman, on the west side of the Canal. The malaria 
rates at the Army stations (Fort Randolph and France Field) on the 
shore line to the east of Colon are, as a rule, ow. 

A number of years ago colored agriculturists were allowed to settle 
on land on the west side of the Canal north of Gatun Dam and along 
the shores of the Chagres River below the dam. Approximately 300 
persons now live in this area; it is across the Canal and about one 
and one-half miles distant from Gatun and Fort Davis, and about six 
miles from Fort Sherman. Three consecutive blood surveys were 
made of the population in that area in July, 1930, and the general 
malaria infection rate was found to be 30 per cent. Preliminary in- 
vestigations and our present knowledge of the epidemiology of malaria 
suggest that the agricultural settlers living in this area act as a 
reservoir for the infection of anopheles mosquitoes and that subsequent 
to their infection an appreciable number of the mosquitoes so infected 
fly to Gatun, Fort Davis, and elsewhere seeking blood and infecting 
individuals in those areas. If this assumption be correct, the solu- 
tion is depopulation of the area. Immediate depopulation would 
necessitate reimbursement to lease holders of approximately $100,000. 
It was decided that pending further investigation no more licenses or 
transfer of licenses would be permitted in the area and that the infected 
individuals living in the area would be treated with quinine. This 
policy was continued throughout the malaria season of 1930, and 
further studies of the situation will be made. 

Special projects undertaken in the southern division — Pedro Miguel, 
Ancon, Balboa, and Panama suburban districts. — No marked extension 
of sanitated areas was undertaken. The Matasnillo River system was 
"trained" to lessen the cost of its maintenance during the dry seasons, 
at which time some Anopheles albimanus breeding usually occurred in 
it. The construction of Albrook Field required some extension to cover 
it, but most of the newly controlled area adjacent to that post is 
rather heavily timbered and shaded so that for the present, control work 
there is liijiited. The new Thatcher Highway now being constructed 
from Balboa to Arraijan, and the new bathing beach at Farfan, have 
opened up considerable areas west of the Pacific end of the Canal 
which must be sanitated. Preliminary surveys have been made and 
some earth ditches installed along the highway. When the concrete 
surface of the highway is completed and opened to trafific it will be 
feasible to perfect these drainage systems and make them permanent 
with concrete tile and sectional inverts. 

Before closing this discussion of the special investigations undertaken 
during 1930, it is fitting to acknowledge our indebtedness to and very 

MR 26916—6 



82 

great appreciation of the cooperation and active assistance rendered 
the Health Department by Dr. H. C. Clark, Director of the Gorgas 
Memorial Institute and his staff. Through his active assistance most 
of the malaria survey work and practically all of the work on trypano- 
somiasis was accomplished. Without his help it could not have been 
done by the limited personnel of this Department. 

HEALTH SERVICES IN THE TWO TERMINAL CITIES, 
PANAMA AND COLON. 

The cities of Panama and Colon, of the Republic of Panama, located 
at the Pacific and Atlantic entrances to the Canal, respectively, are in 
immediate juxtaposition to the Canal Zone settlements Balboa-Ancon 
and Cristobal. To protect the health of the populations involved, to 
prevent the occurrence of epidemics of such diseases as yellow fever, 
plague, etc., and to safeguard and expedite the transit of the immense 
volume of shipping passing through the Canal, it is essential that the 
populations living in the towns and cities located at the Atlantic and 
Pacific terminals be treated as a coordinate whole. To assure adequate 
safeguards of the public health, the treaty entered into between the 
United States of America and the Republic of Panama provides as 
follows: 

The Republic of Panama agrees that the cities of Panama and Colon shall comply 
in perpetuity with the sanitary ordinances whether of a preventive or curative charac- 
ter prescribed by the United States and in case the Government of Panama is unable 
or fails in its duty to enforce this compliance by the cities of Panama and Colon 
with the sanitary ordinances of the United States, the Republic of Panama grants to 
the United States the right and authority to enforce the same. 

After ratification of the treaty, sanitary regulations were promulgated 
and by mutual agreement the Health Department of The Panama 
Canal established and maintains health organizations in the two Pana- 
manian cities. The principal interest of the Canal Zone government 
in the two terminal cities, from the public health point of view, is to 
prevent the occurrence of epidemic diseases in the populations that 
will tend to delay or interfere with shipping, to put into effect such 
sanitary measures as will reduce to the lowest possible minimum the 
occurrence of acute transmissible diseases of which malaria is an exam- 
ple and to reduce the prevalence of insect transmitters of disease to* 
such an extent that the introduction of such diseases as yellow fever, 
plague, etc., would not result in epidemics. 

In the health work done in Panama City and Colon, greatest atten- 
tion is paid to sanitary measures having to do with the environment or 
surroundings rather than hygienic measures which deal with the indi- 



83 

vidual. The health organizations maintained by The Panama Canal 
in Panama City and Colon are operated at the expense of the Health 
Department of The Panama Canal except that three-fourths of the 
costs of street cleaning and garbage collection and disposal in the two 
cities are borne by the Government of Panama. 

The average net cost to the Health Department of The Panama 
Canal of their activities carried on in the city of Panama for the protec- 
tion of the public for the past three years has been as follows: 

Sanitation within the city $36 , 279 . 93 

Health Department's share of the cost of street cleaning and garbage 

collection and disposal 15,824.63 

In addition, the malaria control work in the Panama Surburban Dis- 
trict has averaged, for the past three years.- 23, 103.97 



Total for the protection of Panama City $75,208.53 

In Colon, the average cost for the pas^ three years has been: 

Sanitation within the city $21 ,617. 72 

Health Department's share of the cost of street cleaning and garbage 

collection and disposal 9 , 585 . 84 

Total for the protection of Colon $31,203.56 

During recent years the Panamanian Government has been allotting 
funds for infant and maternal welfare work, examinations of school 
children, venereal disease work, tuberculosis, and other purposes of a 
like nature. Work of this nature is being carried on by different 
departments of the Panamanian Government, each working independ- 
ently, and there has been no coordination between the Panama Canal 
health organization working in Panama City and the health work 
undertaken by the Government of Panama. Recognizing the fact 
that closer cooperation and better coordination of all elements engaged 
in public health activities in Panama City would increase efficiency, 
reduce expenses and make more effective the public health work being 
done, the Surgeon General, United States Public Health Service, was 
requested to detail a competent officer to temporary duty with the 
Health Department of The Panama Canal to study the situation and 
submit a plan that would accomplish the aims in view. Surgeon Paul 
Preble, U. S. P. H. S., was detailed for this purpose. A plan was 
worked out which had in view: Centralization of all public health 
activities under one head ; appointment of a Panamanian physician as 
Assistant Health Officer; and inclusion of Panamanian personnel en- 
gaged in public health acitivities in Panama City (school physicians. 



84 

nurses, etc.) in the proposed organization. The purpose in view was 
to gradually develop a well-rounded health organization for the city 
that would serve as a model to be followed in the extension of health 
services to the provincial districts, to develop Panamanian public 
health personnel who through training and experience in the work 
in Panama City would be available for assignment to health work 
elsewhere throughout the Republic, and to develop more trained 
Panamanian health personnel for permanent assignment to the health 
organization of the city of Panama. 

The plan was submitted informally to the Panamanian Government 
for study and suggestion as to changes that might appear to be advisa- 
ble. No definite action had been taken with regard to this plan at the 
end of the year. 

HEALTH OFFICER, PANAMA CITY. 

The health organization of Panama City consists of a health officer 
who directs the activities of the organization, one physician in general 
charge of routine vaccinations (smallpox) and other immunological 
measures and investigation of cases of acute exanthematous diseases, 
one veterinary surgeon who supervises the dairy industry, one veteri- 
narian who inspects all animals slaughtered at the abattoir and all 
animal foods on sale at markets and other commercial establishments, 
one sanitary inspector in charge of street cleaning and garbage collec- 
tion, one sanitary inspector in charge of building construction and 
repairs (rat-proofing, ventilation, etc.), two sanitary inspectors 
assigned to districts of the city whose principal duties are abatement 
of nuisances, one public health nurse who supervises the work of mid- 
wives and vaccinates new born infants, chief clerk in charge of office, 
two clerks, eight sanitary patrolmen engaged in abatement of nuisances, 
and 110 foremen, laborers and miscellaneous employees in the street 
cleaning, garbage collection, and garbage disposal gangs. 

The following activities are reported by the Health Officer, Panama, 
for 1930: 

Sanitary inspection. — On September 22, 1930, the Health Depart- 
ment discontinued cleaning private properties in the city of Panama 
and since that time have confined their activities in this service to 
providing adequate inspection and follow-up inspection of properties 
throughout the city to insure the maintenance of same in proper sani- 
tary condition and in accordance with the sanitary code. The follow- 
ing notice was sent to all property owners and agents on September 
16, 1930: 



85 

To All Property Owners and Real Estate Agents in Panama City: 

1. On and after September 22, 1930, the Health Department of The Panama Canal 
will discontinue doing janitor work in tenement houses, alleys, and yards in the city 
of Panama and will confine its work in such areas to inspection only. The so-called 
house and yard gangs, whose chief activity during the past has been the removal of 
rubbish, boxes, barrels, etc., from tenement houses, will be discontinued and their 
places will be taken by qualified Sanitary Patrolmen working directly under the super- 
vision of the Sanitary Inspectors. 

2. The duties of the patrolmen will be to inspect and report on sanitary conditions 
of properties throughout the city about once a week, giving particular attention to 
tenement houses. Each patrolman will wear a distinctive uniform and badge so that 
his identity may be known to all, without question. 

3. Owners and agents are requested to have all rubbish, boxes, barrels, discarded 
furniture, etc., from their properties placed on or near the sidewalk so they can be 
removed by the garbage and rubbish trucks. 

4. This method should have some educational advantages, for it is hoped that in 
this way we can teach the people to do most of their own cleaning and thereby improve 
their habits. However, owners and agents will be required to provide adequate and 
satisfactory janitor service for their respective properties and to keep said properties 
in proper sanitary condition at all times as required by the Sanitary Regulations. 

5. The janitor service at present in many tenement houses in Panama City is en- 
tirely inadequate and should be improved at once. 

6. Your valuable cooperation, which is necessary for the success of this measure, is 
earnestly solicited. 

The department experienced no difficulty whatever in instituting this 
change, and from close observation during the past year, the present 
system of inspection is more satisfactory and less expensive than the 
old method of "gang" inspection and cleaning of properties by the 
Health Department. 

The city is divided into eight districts, one sanitary patrolman is 
assigned to each district, which he covers thoroughly once a week, 
going from house to house looking for fly-breeding, mosquito-breeding, 
rat-harborage, and dirty premises. When he finds any such nuisance 
an attempt is made by him to have it corrected then and there and if 
he is unable to do so, he refers the matter to the sanitary inspector for 
necessary action. Two sanitary inspectors supervise the work of these 
8 patrolmen in comparison with 3 sanitary inspectors, 4 foremen, and 
12 laborers formerly used on this work. 

The property owners and agents have cooperated with us in a most 
surprising and generous manner and the janitor service is much im- 
proved. 

OUTLINE OF INSTRUCTIONS FOR SANITARY PATROLMEN. 

The following instructions were given the Sanitary Patrolmen on 
November 15, 1930, in order that they may have a thorough under- 
standing of their duties: 



86 

1. General cleanliness of buildings. — Note condition of sidewalks, floors, alleys, 
yards, drains, kitchens, etc., plumbing fixtures such as toilets, urinals, baths, sinks, 
etc., and whether or not repairs or replacements are needed. 

2. Cleanliness of markets, bakeries, restaurants, ice cream parlors, and stores. — Note 
personal cleanliness of employees such as bakers, butchers, waiters, cooks, etc., and 
request them to keep clean and wear clean clothes as per regulations. Note con- 
dition of tables, scales, counters, chop-blocks, kitchens, ice boxes, refrigerators, etc., 
and insist on their being kept clean. 

3. Rats. — Look for evidence of their presence such as marks on rafters, holes in 
floors, double walls, accumulations of rubbish or poorly stored materials that favor 
their propagation. 

4. Fly-breeding. — Note condition of garbage cans both large and small — or indi- 
vidual, stables, gardens, flower boxes, drains, garbage, rubbish, and manure. Collect 
specimens as evidence. 

Mosquitoes. — Look for breeding in anything that will hold water such as coconut 
shells, broken bottles and crockery, old auto tires, sagging roof gutters, tin cans, 
buckets, barrels, boxes, drains, unused toilets (both bowls and tanks), cangilones, 
flower pots and vases, catch-basins, traps, etc. Collect specimens as evidence. 

6. Condition of. — Floors, drains and patios. 

7. Condition of. — Plumbing and plumbing fixtures such as leaking, choked, dirty, 
etc. 

8. .Storage regulations. — Acquaint yourselves with the storage regulations and see 
that they are complied with. 

9. Exceptionally bad conditions should be immediately reported to the sanitary 
inspector in charge, also insanitary conditions which you are unable to have corrected. 

10. Make out daily written report to the sanitary inspector in charge. 

11. Report promptly on time. Be vigilant and thorough in your inspections. Be 
courteous to everybody at all times. Fill in house cards carefully and correctly and 
do not copy. Do not argue with anyone at any time, when on duty. Be personally 
clean and neat. 

There were 113,284 house-to-house inspections made during the year; 
1,011 mosquito-breeding places and 2,966 fly-breeding places were 
found and destroyed. Only $51 in fines was collected for the violation 
of the Sanitary Regulations. 

Building inspection. — Owners, architects, contractors, and artisans 
cooperated with this office in a gratifying manner. However, it ap- 
pears that some means should be provided for the licensing of artisans, 
so as to prevent incompetent men from posing as artisans and con- 
tracting for jobs for less than the actual cost of the materials, which 
usually results in poor workmanship and construction. 

This office has been recommending the installation of tile or concrete 
floors on all ground floors, for they are more sanitary and economical. 
If the owner does not wish tile or concrete, we request the installation 
of a wide concrete border around the wood floors. 

The fronts of many business houses on the main streets were im- 
proved, and modernized. In most cases the occupant paid for such 



87 

improvements and we did not feel justified in requesting too much, but 
were able to get a large amount of rat-proofing work accomplished in 
all such places. We have been very successful in having fixtures, 
shelving, etc., installed in a rat-proof manner throughout the city. 

One of the chief problems encountered in the rat-proofing of houses 
in Panama City is the elimination of the space between adjoining 
buildings or walls, which in many cases is from 2 inches to 12 inches 
wide and affords excellent harborage for rats. Although considerable 
difficulty is usually encountered in eliminating such spaces, many of 
them were eliminated by the substitution of common walls during 
the year. 

There were 1,112 building permits issued as follows: 

New buildings - 121 

Repairs and alterations to existing buildings 374 

Miscellaneous repairs.... 507 

Installation of fixtures and counters and rat-proofing same 110 

Frequent follow-up inspections were made on all such work to insure 
the proper rat-proofing of same. 

There were 5,651 rats and mice caught in the city, 1,929 were sent to 
the Board of Health LajDoratory at Ancon for examination and were 
classified as follows: 

Mus musculus 1,157 

Mus alexandrinus 6 

Mus norwegicus 28 

Mus rattus 738 

Dairy and milk inspection. — There are 24 dairies supplying milk to 
the city, a small part of the output being sent to Colon and the Canal 
Zone. These dairies contain a total of 2,109 animals; 355 dairy 
cattle and calves from the United States and 35 head from Costa Rica 
were imported during the year and a total of 320 head were exported. 
All dairy cattle were tested for T. B. during the year — only 17 showed 
a positive reaction and were destroyed. The total production of milk 
during the year amounted to 3,462,007 pounds, all of which was pas- 
teurized before distribution; 3,258,358 pounds were sold in one-fifth 
gallon bottles at 20 cents per bottle. The Central de Lecherias 
handled 2,954,709 pounds and the two independent pasteurization 
plants handled 507,298 pounds. 

There has been a steady increase in the per capita consumption for 
the past five years, which is unquestionably due to the pasteurization 
and the improvement in the sanitary condition of dairies and milk 
plants. However, there is still room for improvement particularly in 



88 

the method of distribution, as very few milk dealers or venders have 
sufficient refrigerating facilities for keeping their milk at the proper 
temperature, and as result of this, spoilage is of frequent occurrence. 
An effort is now being made to correct this by the establishment of 
sanitary milk depots by the Cooperative Dairy Association. 

The bacterial content of pasteurized milk in Panama usually runs 
less than 10,000 per c. c. which shows that the milk is of a high quality 
and equal to, if not better than market milk in most cities in the United 
States. 

The Central Pasteurization plant was not properly planned and ar- 
ranged, which necessitated the expenditure of a substantial amount of 
money to cover alterations and rearrangement of the plant. When 
the present program of improvements to this plant is completed it will 
be one of the best plants of its kind in Panama and capable of handling 
three times the present amount of milk at less expense and in a more 
sanitary manner. 

Ice cream. — The four ice cream factories produced 168,658 gallons of 
ice cream during the year. The regulations require the pasteurization 
of the mix and a minimum butter fat of 8 per cent. No difficulty 
was experienced in enforcing these requirements. The bacterial count 
usually runs about 200,000 per c. c. The manufacture and handling 
of ice cream receives frequent and close inspections by the Health 
Department. 

Soft drinks. — The four bottling plants produced 468,000 dozen bot- 
tles of soft drinks, 580,000 frozen suckers, and 300,000 Eskimo pies 
during the year. Each plant is equipped with modern sanitary machin- 
ery and receives frequent rigid inspections by this department to insure 
the purity and cleanliness of the product. 

General food inspection. — Inspection of pasteurization plants, ice 
cream and soft drink plants, markets, ice cream parlors, restaurants, 
clubs, hotels, saloons, breweries, cantinas, stores, warehouses, and all 
other places where food is prepared, manufactured, stored, sold or 
offered for sale, receives frequent inspections, in order to insure the 
maintenance and operation of same in proper sanitary condition and 
that all products therefrom are sound, pure and wholesome. The 
following places receive frequent thorough inspections: 

Markets, municipal— - 1 Breweries.. 2 

Markets, private, and meat stalls . 51 Venders of soft drinks, chicha, etc.. ii 

Bakeries 16 Clubs... 3 

Ice cream manufacturing plants 4 Hotels 7 

Icecream parlors 30 Restaurants 50 

Soft drink manufacturing plants Bars 96 

(bottling works) 4 



89 

Diphtheria. — Dr. H. A. Lewis of this office was placed on special 
detail for the purpose of administering toxin-anti-toxin treatments to 
school children and others applying for same, on December 6, 1929. 

During the 12-month period January 1, 1930 to December 31, 1930, 
9,016 first injections were made and 2,190 complete treatments were 
given. During this period 960 throat and nose cultures of contacts of 
positive cases of diphtheria cases were taken; of these, 8 proved 
positive for diphtheria. 

Garbage disposal. — The garbage from the city of Panama, the Ancon- 
Balboa District, Fort Amador, and Quarry Heights is now disposed of 
at the old dump in the Calidonia section of the city. Approximately 
22,000 tons of garbage were collected from Panama City at a cost of 
$2.04 per ton; the cost of disposal by burial was 48c per ton. 

In order to control fly-breeding on the dump, beginning September, 
1929, all manure from Panama City stables was hauled to the ex- 
perimental garden at Summit. The total amount disposed of in this 
manner was approximately 628 tons, the cost per ton for collection 
and disposal being $4. 

The new system, adopted during the year, of burying garbage only 
and eliminating the burial of miscellaneous containers (all potential 
mosquito breeders) reduced dump maintenance, but it has not pre- 
vented fires from spontaneous combustion, as such fires are more 
frequent now than ever. 

Veterinary work. — At the municipal abattoir, 14,397 cattle were 
slaughtered of which 49 were condemned as unfit for food on account 
of the following conditions: Congestion, 7; tuberculosis, 1; septi- 
cemia, 3; extensive bruises, 16; pneumonia,. 1; enteritis, 6; moribund, 
15 

There were 15,150 hogs slaughtered at the municipal abattoir of 
which 698 were condemned as unfit for food on account of the following 
conditions: Exhaustion, 19; cysticercosis, 598; cholera, 66; tubercu- 
losis, 1; icterus, 1; septicemia, 11; extensive bruises, 1; cachexia, 1. 

Inspections were made of 11,077 cattle and 4,113 hogs for shipment 
to the Atlantic side. Certificates were issued for 20,761 hides from ani- 
mals slaughtered at the municipal abattoir, which had received ante- 
mortem and post-mortem examinations, and from animals slaughtered 
in the interior, hides from which were disinfected under the super- 
vision of our veterinarians. 

For a number of years it had increasingly become the custom in 
Panama City to install water-containing devices (ant'-guards or cangi- 
lones) around growing plants to protect them against the incursions 
of ants. From time to time efforts had been made to break up the 



90 

practice, but without results. Investigation demonstrated that several 
thousand ant-guards were in use in Panama City. As these devices 
were ideal breeding places for certain species of mosquitoes, particularly 
the species which transmits yellow fever and dengue fever, it was 
decided that their abolishment was a necessary public health measure. 

A circular covering the matter was prepared, translated into Spanish, 
given publicity in the English and Spanish sections of the newspapers 
and reprinted in both English and Spanish and distributed to house- 
holders. The municipal authorities, the property owners, and the 
press cooperated whole-heartedly, and the ant-guards (cangilones) were 
quickly eliminated. 

The circular distributed was as follows: 

HEALTH DEPARTMENT DECLARES WAR ON DOMESTIC 
MOSQUITOES IN PANAMA CITY. 

MANY FOUND BREEDING IN ANT-GUARDS THROUGHOUT THE CITY. 
THE USE OF SUCH MOSQUITO HATCHERIES TO BE PROHIBITED AFTER JANUARY 1, 1931. 



As the Health Department proposes, in the immediate future, to secure compliance 
with Sees. 189 and 190 of the "Sanitary Rules and Regulations" in the cities of Pana- 
ma and Colon, relative to mosquito breeding, it is deemed advisable to explain to the 
populations involved just what those regulations are, the manner in which they are 
being violated and why certain potential and actual mosquito breeding places must be 
eliminated, particularly the ant-guards (cangilones) in cemeteries and in the patios 
and gardens of private houses. 

During the present rainy season many residents of the two terminal cities and the 
Canal Zone have complained, ag is always the case at this season of the year, of the 
mosquito pest. The older residents who are close observers and who have retentive 
memories have no such complaints to offer, as they have vivid recollections of condi- 
tions in the past as compared with the present. 

It is a fact that a certain species of mosquito (Aedes taeniorhynchus) makes it way 
into the terminal cities and the Canal Zone at certain seasons of the year from breed- 
ing places far distant (5 to probably 40 miles or more) and, from a practical point of 
view, it is and for many years will be quite impossible to eliminate them. Fortunate- 
ly, their seasonal flights are of short duration and though they bite viciously and con- 
stitute a veritable pest, they have not been incriminated as carriers of disease. 

Other species, such as the highly domesticated Culex qtiinquefasciatus, commonly 
known throughout the world as the house mosquito, and the Aedes egypti, commonly- 
designated as the yellow fever and dengue fever mosquito, breed usually and almost 
exclusively within or in close pro.ximity to human habitations. 

In general terms, it may be stated that these two species breed in tin cans, broken 
bottles, flower vases, discarded automobile tires, drip basins under ice boxes, cangi- 
lones and trenches around tombs, cans or saucers placed under legs of tables and ice 
boxes to guard against incursions by ants, depressions in the soil, and, in fact, in any- 
thing that contains open collections of water. 



91 

It is of the utmost importance to recognize the fact that any water allowed to re- 
main in open receptacles of any nature for a period of a week to ten days is a potential 
breeding place for the house mosquito and the yellow fever mosquito. 

When complaints of undue prevalence of mosquitoes within residences reach the 
Health Department, it is the practice to have an inspector search for breeding places 
within or in the immediate vicinity of the house. Usually breeding is found in casual 
collections of water in receptacles of the nature referred to above. Such breeding is 
due to carelessness on the part of the householder and lack of appreciation of the 
breeding habits of these mosquitoes. In some instances the mosquitoes breeding 
within houses are found to be so many in number as to constitute a pest not only to 
the occupants of the house itself, but to all the neighbors in the immediate vicinity. 

It is impracticable, for many reasons that are obvious, for the Health Department 
inspectors to search for breeding at weekly intervals inside all houses in residential 
districts, and while such breeding can be eliminated when reported, it can be prevent- 
ed only through intelligent cooperation on the part of the public. As long as the 
responsible individual permits water to remain for seven days or longer In flower 
vases. In cans or saucers under table legs. In drip pans under refrigerators, or In 
any other receptacle within the house or In the patios or yards, potential breeding 
places exist and swarms of mosquitoes may be anticipated at any time. 

Public health authorities in tropical and subtropical climates, particularly In 
Brazil, where epidemics of yellow fever recently have prevailed, are forbidding the use 
of water In flower vases and are substituting therefor sand in the vases, to which 
sufficient water is added to saturate the sand but leaving no film of water on its sur- 
face. 

The breeding of mosquitoes in containers placed under the legs of tables and refrig- 
erators can be prevented by changing the water once each week and scrubbing the 
containers or by keeping the water covered with a film of kerosene and changing It at 
less frequent Intervals. 

The most serious and Important potential and actual breeding places for the yellow 
fever mosquitoes (Aedes egypti) that exist in Panama City at the present time are the 
so-called ant-guards or cangilones (open rings manufactured of concrete or of clay 
convex on lower surface and concave on upper for holding water), surrounding grow- 
ing plants in cemeteries and in the yards and patios of private residences. 

The older residents of the Isthmus, who lived here during the period of construction 
by the French Company, will recall that efi'orts were made to beautify the grounds 
around hospitals and the residences of higher officials by planting flowers and shrub- 
bery. Following the custom in vogue the young plants were surrounded by ant- 
guards, which were kept full of water. It is a matter of record that the death rates 
from yellow fever in those days were especially high among higher officials and their 
families. It is known now that the collections of water in the ant-guards constituted 
ideal breeding places for the yellow fever mosquito and that the high prevalence of 
yellow fever among the higher officials and in the hospital wards was attributable to 
the excessive numbers of this species of mosquito in and around the hospitals and resi- 
dences. Ant-guards of this nature are now strictly prohibited in the Canal Zone. 

For a number of years past, in Panama City, the custom of placing cangilones 
around young plants in the patios and gardens of private residences, and particularly 
so in cemeteries, has been growing. Recently the Health Department of Panama 
City made a cavass of cangilones now existing In the cemeteries and Bella Vista and 
found more than 3,000 such containers. A census of the entire city would Increase 
these figures substantially. Many of the cangilones in private premises and all in 



92 

the cemeteries are inspected and subjected to treatment at weekly intervals and the 
yellow fever and culex mosquitoes are found breeding in a considerable proportion of 
the containers at each inspection. Occasionally, however, malaria transmitting mos- 
quitoes are found breeding in cangilones in the Bella Vista section of the city. 

Obviously an enormous amount of work is entailed in the inspection and oiling of 
cangilones at stated intervals and notwithstanding constant search for new and 
already existing ones, doubtless many cangilones on private premises throughout 
the city are never seen. 

If it could be assumed that the useful purpose served by cangilones outweighed their 
menace to the comfort, well-being and health of the community as a whole, the Health 
Department would gladly continue this supervisory work, but such is not the case. 
The water kept in cangilones is supposed to prevent ants gaining access to the plant, 
and though this may be the case in isolated instances, investigation made by the 
Health Department demonstrates that in most instances the ants do gain access at 
one time or another. 

Repeated inspections of cangilones in cemeteries discloses the fact that, at any 
given inspection, ants can and do cross the body of water in the container either on 
bridges formed by falling leaves, blades of grass, twigs or other deposits or by tunnel- 
ing underneath the cangilones, in the case of approximately two-thirds of the cangi- 
lones inspected. Conditions in this respect change from day to day, being dependent 
on falling leaves, twigs, etc., blown hither and thither by the wind and rain, and it may 
safely be assumed that the percentage of efficiency of cangilones is practically nil in 
all cemeteries and most residential districts. In residential districts, inspectors 
report that mosquitoes are constantly found to be breeding in one or more cangilones 
on most premises. This notwithstanding the fact that explicit instructions regarding 
their care are given householders. 

The statement is more than justified that the mosquitoes constantly being bred in 
cangilones throughout the city of Panama constitute a menace to the health, comfort 
and well-being of the population, w^hich far outweighs any useful purpose served by 
them as a protection against the incursions of ants. 

Furthermore, it may be pointed out that since the American occupation their use 
has always been prohibited on the Canal Zone, and notwithstanding this prohibition, 
no serious difficulty is experienced in raising plants and flowers. 

In view of the statements made above, the Health Department will hereafter con- 
sider cangilones, and all other such water-containing guards for plants as sanitary 
nuisances and will take the steps necessary to abate this nuisance, as authorized in 
sections 189, 190, and 191 of Sanitary Rules and Regulations for the cities of Panama 
and Colon. 

The regulations are as follows: 

Sec. 189. The breeding of mosquitoes in or on any place or premises is declared to be a nuisance. 

Sec. 190. .•Ml premises must be kept in such a condition as to prevent mosquito breeding, and upon 
failure of the owner, agent, or occupant of such premises to correct the insanitary conditions thereon 
after notice from the Health Officer or his representative, he shall be fined as hereinafter provided, and 
the Health Officer may proceed to correct such condition, the cost of the same to be a charge against * 
the delinquent person to be collected under execution against his property. 

Sec. 191. A violation of any of the provisions of sections 186 to 190, inclusive, of these regulations, 
shall be punished by a fine of not less than five balboas nor more than twenty-five balboas for each 
offense. 

Before enforcing these regulations, in so far as cangilones are concerned, it is felt 

that those directly concerned should be notified of the action that will be taken by the 

Health Department with respect to this nuisance. It is also felt that only through 

whole-hearted, sympathetic and intelligent cooperation on the part of the public can 



93 

this nuisance be quickly eliminated, and it is to secure this cooperation that this public 
statement is offered. 

It is therefore requested that owners of property or persons residing in leased prop- 
erty having cangilones or other type guards on their premises, and that authorities 
in charge of cemeteries, remove all cangilones and water trenches on tombs, prior to 
January 1, 1931. Immediately after January 1, 1931, inspections of properties for 
cangilones will be undertaken. If any cangilones are found, the owner or persons 
resident therein will be furnished a copy of this notice (in English or Spanish, as the 
case may be) and directed to abate the nuisance within 24 hours. If on reinspection 
the cangilones have not been destroyed, the owner of the property or the individual 
residing thereon will be fined in accordance with the provisions of section 191, Sani- 
tary Rules and Regulations, quoted in this statement, and the Health Department 
may proceed to abate same at the owner's expense. 

If those directly concerned will cooperate in ridding the city of cangilones, and 
householders will exercise more care in eliminating other breeding places within their 
homes and in their yards, an appreciable reduction in the mosquito population of the 
the city of Panama may be anticipated. 

In this connection, we must reemphasize the statement that the A. taeniorhynchus, 
which breeds in coastal swamps extending from Old Panama to Chepo, will, on ac- 
count of its long flights, continue to be a pest at intervals, especially during the early 
weeks of the rainy season, depending on the intervals between rains and amount of 
rainfall. 

It is perhaps pertinent here to devote a few words to the presence of Anopheles 
mosquitoes in the sanitated areas; it is mosquitoes of this genus that carry the germs 
of malaria from one person to another. Records in the Chief Health Office indicate 
that conditions are now incomparably better in this respect than they were when the 
Canal was under construction, or even at the time that work had been just completed. 
For instance, in a period of 14 months, from April 1, 1914, to May 31, 1915, there were 
captured indoors of quarters, the following numbers of Anopheles : Ancon, 5,640; 
Corozal, 5,808; Gatun, 26,541. In these same towns it is now the rarest of events for a 
single Anopheles even to be seen indoors in a whole year's time. Although a few such 
mosquitoes may, and doubtless do, invade the towns, they very seldom obtain access 
to the inside of screened buildings. Throughout the year frequent observations are 
made at night to determine if there are any such mosquitoes flying into the sanitated 
areas. Occasionally there is evidence that some such invasion is occurring from the 
large unsanitated areas that lie on every side of the lands in which mosquito control 
is practiced. The Canal Zone towns may be considered as being amply protected, 
as far as practical measures permit. 

To go any further with the drainage and oiling would give but a small additional 
margin of protection to the Zone and its employees. But such extension on the 
Pacific side would benefit enormously the outlying parts of Panama City and its 
rapidly developing suburban towns. It is hoped that before many months have 
passed there may be a method devised whereby cooperative action on the part of 
the two governments will permit of a consistent effort at such extension in the vast 
coastal marshes east of Panama City, at least far enough to include and protect the 
populous towns of Juan Diaz and Pueblo Nuevo. 

The morbidity and mortality reports and other vital statistics relat- 
ing to Panama City are incorporated in the section on vital statistics 
appearing in this report. 



94 
HEALTH OFFICER, COLON. 

The organization and activities of the health service maintained in 
Colon are similar to that of Panama City, except that a smaller force 
is required as Cristobal-Colon is smaller in size than Panama City. 

The following report of the Health Office, Cristobal-Colon, for 1930 
is submitted : 

Free clinic. — This clinic is operated jointly by the Cristobal Woman's 
Club and the Health Department. It is conducted primarily for in- 
fant welfare work, postnatal and prenatal cases, eye, ear, nose and 
throat cases, dental cases, and such other general work among the poor 
of Colon as time and funds permit. Following is a report of treatments 
given and formulas prepared during the year: 

Babies and children under six ._ 2,248 

Prenatal and postnatal 302 

Eye, ear, nose and throat 1,021 

Feedings (formulas) for babies 12,518 

Referred to Dr. Eno._ 394 

Referred to Dr. Doten (dentist) 37 

Referred to hospitals : 370 

Medical and surgical 1 , 134 

Other work performed by district nurse : 

Vaccinations 1 ,800 

Specimens to laboratory.. 1 ,029 

Home visits 4,294 

Building inspection work. — One hundred and nine plans for new 
buildings or major repairs were approved during the year and 897 
permits for repairs issued. The policy of requiring owners to place 
their buildings in good repair before renewals of Panama Railroad 
leases are recommended has been closely followed. 

Garbage collection and disposal. — Garbage and rubbish to the amount 
of 27,252 tons was handled at the Silver City dump by the burial 
method. Of this amount 22,530 tons were collected by Health Depart- 
ment trucks and 4,722 tons were delivered to the dump by others. 
Fly breeding has been satisfactorily controlled. The cost amounted to 
approximately $L54 per ton for collection and 58 cents per ton for 
disposal. 

Mt. Hope cemetery. — There were 524 burials during the year. 
Receipts from burials were $3,927.28; from sales of flowers, $1,275.80; 
miscellaneous receipts, $19.06. 



95 

Veterinary and meat inspection work. Colon abattoir. — There were 
4,774 cattle slaughtered during the year, of which 30 were condemned 
as unfit for food on account of the following conditions: Septicemia, 6; 
extensive bruises, 3; gangrene, 2; dying condition, 6; pneumonia, 3; 
pus contamination, 1; emaciation, 3; died in pen, 6. 

Hogs to the number of 6,748 were slaughtered and 375 of this num- 
ber were condemned on account of the following conditions : Cysticer- 
cosis, 225; pyemia, 19; dying condition, 4; nephritis, 1; septicemia, 17; 
pneumonia, 6; died in pen, 24; emaciation, 12; extensive bruises, 8; 
enteritis, 1; cholera, 56; gangrene, 2. 

Mt. Hope abattoir.— There were 8,586 cattle slaughtered during the 
year and 33 of this number were condemned for causes as follows : Tu- 
berculosis, 12; septicemia, 3; died of injuries, 4; emaciation, 2; died in 
pen, 5; extensive bruises, 4; pneumonia, 3; 

Dairies. — Seventeen dairies supplying milk to this district produce 
about 775 gallons of milk daily. In addition, 150 gallons of milk pro- 
duced in the Panama district is received daily at the Mt. Hope plant 
of The Panama Canal. All milk produced in this district is pasteur- 
ized and bottled in three modern plants, one of which is operated by 
The Panama Canal at Mt. Hope, and two by private interests in Colon. 
The tuberculin test was given to 1,184 dairy animals and two reactors 
were killed. 

Two hundred and seventy-five samples of milk and ice cream were 
sent to the laboratory for bacteriological examination and chemical 
analysis. 

Quarantine inspections. — Inspections of animals entering the port 
of Cristobal were as follows: 616 cattle, 47 horses, 85 mules, 127 sheep. 

Food establishments. — The number of inspections made of establish- 
ments manufacturing or selling foodstuffs were: Bakeries, 311 ; dairies- 
milk plants, 266; bottling plants, 150; markets, 688; ice cream plants, 
196; ice cream parlors, 260; restaurants, 796. 

The morbidity and mortality reports and other vital statistics relat- 
ing to the city of Colon will be found in the section on vital statistics 
in this annual report. 

DIVISION OF HYGIENE. 

For a number of years it has been the custom to physically examine 
each year the school children on the Canal Zone, these examinations 
being conducted by district physicians and other medical personnel 
temporarily assigned to such duty. It should be explained in this 



96 



connection that children having defects requiring correction are re- 
ferred to the proper hospital clinic for further examination and neces- 
sary treatment. 

From time to time the Health Department has also had on duty on 
the Pacific side a public health nurse whose duties have been to do 
visiting nursing service, to develop child welfare clinics, to cooperate 
with voluntary welfare organizations of one kind or another, to super- 
vise the work of midwives, to check the vaccination status of infants 
who have reached the age of three months, and to perform other work 
of a similar nature. 

W^ork of like nature has been carried on continuously for a number of 
years in connection with the health service in Cristobal-Colon. 

A study of the local situation in 1929 and during the early months of 
1930, suggested the desirability of further developing this type of 
service particularly in the Canal Zone communities on the Pacific side 
and more especially in the communities of colored people. Physical 
examinations of school children had been done by various physicians 
and as is naturally to be expected, under such conditions, there was 
not uniformity in the classes and types of defects noted and reported. 
It was felt that the assignment permanently of one physician to this 
work, examination of all school children (white and colored) by this 
one physician, and a thorough understanding on his part of the scope 
of the examination to be made, would result in the collection of more 
accurately comparable data for analysis and estimation of the most 
serious defects in the children and those most urgently requiring cor- 
rection. This procedure was followed and all school children on the 
Pacific side (white and colored) were examined. Analysis of the data 
indicated that the percentage showing defects of the teeth were abnor- 
mally high. Through cooperation on the part of District Dentists, and 
officers of the dental services of the Army and Navy on duty in the 
Canal Zone, it was possible to make a dental survey of representative 
samples of the colored school children. 

The results of the general physical examinations of school children 
are shown in the following tables: 



PHYSICAL EXAMINATION, ZONE SCHOOL CHILDREN (PACIFIC SIDE), 1929-1930. 





Total. 


White. 


Colored. 




Boys. 


Girls. 


Boys. 


Girls. 


Total 


918 
318 
600 


Percent. 

"u.i 

65.3 


905 
240 
665 


Percent. 
73.5 


1,028 
150 

878 


Percent. 

'■'i4.5 
85.5 


929 
141 

788 


Percent. 


Normal 

Defective 


15.1 
84.9 



97 



PHYSICAL EXAMINATION, ZONE SCHOOL CHILDREN (PACIFIC SIDE), 1929-1930— Continued. 

SUMMARY OP DEFECTS. 





White. 


Negro. 




Boys. 


Girls. 


Boys. 


Girls. 


Weight 


257 

146 

55 

14 

213 

170 

21 



2 


Per cent. 

28.0 

15.9 

6.0 

1.5 

23.2 

18.5 

2.3 

0.0 

0.2 


344 

168 

81 

3 

208 

176 

7 

3 



81 

5 


Per cent. 
37.7 
18.5 
8.9 
0.3 
23.0 
19.4 
0.7 
0.3 
0.0 
8.9 
0.5 


285 
94 
92 
26 
533 
569 
3 

40 


Per cent. 

27.7 

9.1 

8.9 

2.5 

51.8 

55.3 

0.8 

0.0 

3.9 


218 

138 

44 

13 

479 

495 

5 



31 

1 

5 


Per cent. 
23 4 


Eves 


14 8 


Ears 


4 7 




1.4 


Teeth 


51 5 


Tonsils .• 


53.2 


Cardiac 


0.5 
0.0 


Skin 


3 


Thyroid 


1 


Bones 


11 

157 

3 


1.2 
17.1 
0.4 


9 

678 

13 


0.8 

65.9 

1.2 


0.5 






















Total 


1,049 




1,076 




2,342 




1,429 









The following remarks are offered to clarify the above table compiled 
from the examination of 3,780 Canal Zone school children during the 
months of January to May, 1930. Children attending the following 
schools were examined: White — Ancon, Balboa (high school, grades, 
and kindergarten), Pedro Miguel, and Parai^o "Spanish School." 
Colored — Red tank, Paraiso, Gamboa, and La Boca schools. 

Of the 1,823 white children examined, 558, or 30 per cent, were found 
to be free from all of the "defects" tabulated and were classified as 
"normal." The percentage was slightly higher among the boys than 
among the girls shown in the table. Of the 1,957 colored children, 
291, or 15.3 per cent, were classified as "normal," the proportion of 
boys to girls being practically equal. . 

All children having one or more of the defects tabulated were classi- 
fied as "defective," except as noted below. 

Weight. — Age-height-weight scales based on the examination of 
white American school children were used as the basis for determina- 
tion of theoretical weights of the white children. All children more 
than 10 per cent above or below the theoretical weight were classified 
as defective. The percentage of those overweight was negligible. The 
relatively high percentage {33 per cent) of underweight white children 
may indicate a reaction to local climatic conditions. 

Theoretical weights of colored children were based on statistics from 
a United States Public Health Report dealing with the examination 
of a group of American colored children. An average of 25 per cent of 
all the colored children examined were defective in this respect. 

Eyes. — Vision was tested by means of the "Snellen" 20-foot eye 
chart, using the "Illiterate E" chart for younger children. Kinder- 
garten children were not examined. Vision of less than 20/20 in one 
or both eyes was recorded as "defective," but parents of only those 
children having less than 20/30 vision were notified of the defect. 

MR 26916—7' 



98 

Ears. — Defects noted included the locally prevalent fungus infection 
of the external ear, impacted cerumen, and a few post-operative 
mastoids. Only in a few were gross defects in hearing noted. 

Nose. — Relatively few organic nasal defects were noted. Cases of 
defective nasal breathing were probably due to adenoid growths for 
the most part. 

Teeth. — Under this heading were grouped all children having one or 
more carious teeth, either temporary or permanent, or teeth in poor 
alignment. The high percentage noted (white, 23 per cent; colored, 51 
per cent) would, doubtless, have been much higher had this feature 
of the examination been performed by a dentist competent of judging 
earlier abnormalities. 

Tonsils. — All children with hypertrophied or grossly infected tonsils 
were listed as defective. 

Cardiac. — All cases departing from the normal in any respect were 
notified, in order to secure a more thorough examination. 

Pulmonary. — The only defect found was a mild bronchitis in three 
instances. No cases suspicious of tuberculosis were found. 

Skin. — Considering the prevalence of skin infection on the Isthmus 
the incidence of active infection among the school children is relatively 
slight. 

Thyroid. — Among 203 girls attending the Balboa High School, 60, or 
29.5 per cent, showed a slight to moderate enlargement of the thyroid 
gland. Of these, three were somewhat underweight and had an elevated 
blood pressure, while five were somewhat overweight and had a low 
blood pressure. Nervous signs were entirely lacking. An additional 
21 instances of thyroid enlargement were noted among the white 
grade-school girls. This feature was noted in only one instance among 
the colored girls examined. Probably this finding indicates merely a 
simple hypertrophy of adolescence. 

Bones. — Defects included both traumatic and metabolic structural 
changes. 

Hernias and genitals. — With the exception of the Ancon grade school 
and Balboa kindergarten boys, all boys were examined for hernia and, 
incidentally, need of circumcision. The three hernias noted among 
white boys were all inguinal in location and mild in degree, the thirteen 
among colored boys were all umbilical and mild to moderate in degree.* 
In many instances elongation of the foreskin was the only defect found. 
These boys were tabulated as "normal," but the lesions were also in- 
cluded under the total for "genital" lesions. 

Conclusions. — (1) White Canal Zone school children as a class ap- 
pear to be in good general physical condition, with the exception of the 



99 



fact that a rather high percentage (33 per cent) are underweight as 
compared to States' standards. 

(2) The striking feature in the examination of the colored children 
was the abominable status of dental hygiene. A gratifying improve- 
ment in this feature has resulted from the painstaking follow-up work 
of the District Health Nurse. 

The appended tables summarize the results which were recorded in 
the special dental survey of pupils in the colored schools of the Canal 
Zone made during November, 1930. 

The total enrollment in all of the colored schools of the Zone is ap- 
proximately 4,000. Of this number, 1,505, or nearly 38 per cent, were 
examined as follows: (a) 636 in La Boca by Maj. Daniel Bratton, U. S. 
Army, and Lieut. Commander P. H. Maclnnis, U. S. Navy; (b) 482 in 
Red Tank by Dr. B. L. Warner and Maj. H. R. Finley, Dental Corps, 
U. S. Army; (c) 387 in Silver City by Dr. V. Prier and Dr. C. E. 
Safford. 

The findings as recorded in the following tables indicate that the 
teeth of the colored school children are in very poor condition and that 
health department activities should make some provision for supplying 
dental relief to this group of the Zone population. 

An interesting observation made but not recorded in the tables is 
that, of the total pupils examined, only 4 or 5 showed a permanent fill- 
ing. It appears that, except for the few fillings noted, the only dental 
work performed has been an occasional extraction of a troublesome or 
aching tooth. 

SUMMARY OF DENTAL EXAMINATIONS AND FINDINGS BY SCHOOLS. 



1 Fillings needed. j Extractions needed. 

j 1 


Irregular 
arches. 


Mouths 
needing 
work. 


Normal 
mouths. 


Total 
exam- 


1 Decidious 


Permanent 


Decidious 


Permanent 


ined. 


La Boca I 139 

Red Tank 215 


93 
714 
937 


660 
583 
678 


169 
202 
164 


30 
68 
44 


430 
435 
368 


206 
47 
19 


636 
482 


Silver City 581 


387 






All schools 935 


1,744 


1,921 


535 


142 1 1.233 


272 


1,505 











PERCENTAGE OF THOSE EXAMINED SHOWING- 





Irregular 
arches. 


Needing 
dental work. 


Normal. 




Per cent. 
4.7 
14.1 
11.4 


Per cent. 
67.6 
90.2 
95.0 


Per cent. 
32.4 


Red Tank 


9 8 


Silver City 


5.1 








9.4 


81.9 


18 1 







100 

FINDINGS ACCORDING TO AGE. 



Age. 


Normal. 


Needing 
dental 
work. 


Total. 


Per cent 
normal. 


Per cent 

needing 

dental 

work. 


6 


34 
35 
39 
39 
44 
41 
24 
12 
4 


127 

205 

224 

203 

176 

128 

88 

46 

21 

7 

8 


161 
240 
263 
242 
220 
169 
112 
58 
25 
7 
8 


21.0 
14.6 
14.8 
16.1 
20.0 
24.2 
21.2 
20.7 
16.0 


79 


7 


85 4 


8... 


85 2 


9 


83 9 


10 

11 


80.0 
75 8 


12 


78 8 


13 

14 


79.3 
84 


15 


100 


16 






100 










Total 


272 


1,233 


1,505 













RECAPITUL.4TI0N— TOTAL FINDINGS. 

360 children need 935 decidious teeth filled. 

544 children need 1,744 permanent teeth filled. 

698 children need 1,921 decidious teeth extracted. 

242 children need 535 permanent teeth extracted. 

142 children have irregular arches. 
1,233 children need work of some description. 

272 children have norioal teeth and arches. 
1,505 children examined. 

As a result of the work on examination of school children, items have 
been included in the budget for the fiscal year beginning July 1, 1931, 
for the employment of a school physician and a school dentist. 

It also is proposed, if funds are available in 1931, to establish a 
veneral disease out-patient clinic, the principal activity of which will 
be the treatment of alien (colored) employees with syphilis. 

REPORT OF DISTRICT NURSE. 
Miss Louisa Kurath, Public Health Nurse, Pacific District. 

There has been a gratifying increase in attendance at the clinics held 
once a week at several convenient points on the Pacific side where 
children are weighed and the parents advised as to diet. 

Ayerage number of children on rolls of clinics .-. , 439 

Total attendance at clinics during year._ 2,564 

Number of visits to cases of tuberculosis 116 

Number of other visits to homes .— 851 

The public health nurse gave a series of health talks upon various 
subjects, including teeth, food, bacteria, flies, and malaria, to school 
children both white and colored; 176 talks were given to 195 classes. 
It is believed that the interest aroused by these talks has increased the* 
attendance at the clinics. Many children who were underweight have 
shown a steady improvement under this supervision. 

All cases of tuberculosis are reported to the nurse when discharged 
from the hospital and visits are made to them once a month to advise 
as to necessary precautions, diet, and treatment. The other members 



101 

of families are advised to report to the clinic for periodic examination. 
A total of 116 visits was made during the year to cases of tuberculosis. 
New babies were visited regularly and the mothers advised as to 
their diet and care. They are urged to bring the babies to the clinics 
once a week so that the weight may be watched and the diet changed 
when necessary. 

DIVISION OF QUARANTINE. 

Dr. M. Flint Haralson, Surgeon, U. S. P. H. S. 

Chief Quarantine Ofificer. 

The Division of Quarantine operates two boarding stations, one at 
each terminus of the Canal. Quarters are available at the Balboa sta- 
tion for the normal detention and care of about 400 persons. One 
building, with a capacity for 92 people, is reserved for the use of cabin 
passengers; this building is divided into rooms, each of which accom- 
modates 4 persons. The other buildings, of the barracks type, are for 
the use of steerage passengers and members of crews of vessels. Four 
medical officers, one inspector and necessary silver personnel are on 
duty at each of the boarding stations. 

Due to the number of persons detained at the Balboa station for 
deportation and particularly to Chinese in transit, it has been neces- 
sary to erect an 8-foot wire fence, with an additional 2-foot overhang, 
on metal posts set in a concrete base, around the quarantine reservation. 

There were 417 commercial airplanes given quarantine inspection, 
which was approximately twice the number inspected the previous year. 
Two lines were operated by the Pan American Airways, Inc.; one to 
Miami, Fla., via Cuba and Nicaragua, twice a week (in December, 1930, 
the route was changed to Miami, Cuba and Kingston, Jamaica) ; the 
other to Brownsville, Texas, via Mexico and points in Central America, 
twice a week. The Pan American-Grace Airways operates from the 
Canal Zone to Peru twice a week, while the Scadta Lines (The Sociedad 
Colombo-Alemana de Trasportes Aereos) operate to Colombia, South 
America, once a week. These lines carry mail and passengers. There 
is also a line flying between the Atlantic and Pacific terminals of the 
Canal which carries passengers only. This line, the Isthmian Airways 
Inc., makes three round-trips daily. As it operates within the Canal 
Zone only, no quarantine inspection is required. 

Routine inspection of arriving vessels was maintained to prevent the 
entrance of quarantinable diseases into the Canal Zone. No vessels 
were detained on account of the presence of a quarantinable disease on 
board. Particular attention was given to vessels arriving from plague- 



102 

infected ports. It is believed that, of all quarantinable diseases, the 
entrance of plague into the Canal Zone is the greatest potential menace. 
All vessels docking at Canal Zone ports are required to breast-off four 
feet from the piers and to be properly rat-guarded at all times. The 
building regulations of the Canal Zone and Panama and Colon require 
that every structure be built to afford a minimum of harborage for rats. 

Inspection of vessels was performed promptly and efficiently, and 
shipping expedited as much as possible. The regular hours for board- 
ing vessels at Canal Zone ports are from sunrise to 10 p. m. 

The fumigation of vessels was further improved by the use of 
"Discoids/' This preparation, manufactured by the Fumigators 
Supply Company, Inc., of New York City, is hydrocyanic acid which 
is absorbed in an inert material of a porous nature, such as wood or 
paper pulp. The inert material is cut in the form of thin discs. It 
is supplied in two sizes; the 16-oz. container has 64 Discoids each con- 
taining j-oz. of HCN while the 40-oz. container has 80 Discoids each 
containing |-oz. of HCN. Discoids have proved thoroughly satisfac- 
tory for the extermination of rats and particularly in the destruction of 
vermin. 

The Division of Quarantine continues to supervise the fumigation of 
animal foodstuffs imported from regions of South America where foot- 
and-mouth disease of cattle prevails. During the year, 159 box-car 
loads of such animal foods were fumigated. 

Officers of the division are also the immigration officers for The 
Panama Canal. The division cooperates with the immigration service 
of the Republic of Panama in the enforcement of their immigration 
laws, and quarantine officers perform this additional duty. Since 
Balboa and Cristobal are the principal ports of entry for the Republic 
of Panama, practically all individuals destined to Panama enter at one 
of these ports. All persons who possess the necessary credentials are 
allowed to enter Panama without further formality. Those who have 
not complied with all the provisions of the Panamanian immigration 
laws are detained temporarily and referred to the Panamanian authori- 
ties for final disposition. The immigration activity which the division 
performs is becoming more and more time-consuming in view of the 
increasing number of tourists and visitors who come to the Canal Zone^ 
and the Republic of Panama. There were 788 persons detained at the 
Balboa station under the provisions of the immigration laws for a total 
of 7,618 detention days. 

In May and June the Chief Quarantine Officer visited nearby Carib- 
bean ports of South America, Trinidad, the Lesser Antilles, and the 
West Indies, where sanitary conditions were observed. 



103 



REPORT OF DIVISION OF QUARANTINE FOR CALENDAR YEAR, 1930. 



Balboa. 



Cristobal. 



Total. 



Airplanes inspected and passed 

Vessels inspected and passed 

Vessels granted pratique by radio 

Vessels passed on certificates of masters . 
Vessels issued provisional p^tique 



Total . 



Crew inspected and passed (airplanes included) 

Crew passed by radio 

Crew passed on certificates of masters 

Passengers inspected and passed (airplanes included) . 

Passengers passed by radio 

Passengers passed on certificates of masters 



Total . 



Vessels detained in quarantine 

Supplementary inspection of vessels. 

Vessels fumigated 

Rats recovered after fumigation .... 
Box cars fumigated 



Crew detained in quarantine on board ship 

Passengers detained in quarantine on board ship 

Crew admitted to station account of quarantine laws 

Passengers admitted to station account of quarantine laws. 

Number of detention days at station for month 

Persons admitted to station account of immigration laws . . 

Number of detention days for month 

Persons held or detained for investigation and released .... 
Persons deported under immigration laws 

Rations issued: 

Cabin passengers 

Steerage passengers 

Gold employees 

Silver employees 



Total. 



18 

877 

50 

2,232 



399 
1,974 

111 
1,881 



3,177 



4,365 



43,405 
20,944 
114,373 
15,805 
1,794 
30,434 



14,890 
61,839 
208,487 
87,823 
2,753 
15,156 



226,755 



390,948 



614 
26 
22 
60 



3,735 

60 

232 



788 

7,618 

206 

418 



71 
673 



462 
7,156 

461 
5,990 



14,069 



417 
2,851 

161 
4,113 



7,542 



58,295 
82,783 
322,860 
103,628 
4,547 
45,590 



617.703 



4,349 

86 

254 

159 



788 
7,618 

277 
1,091 



462 
7,156 

461 
5,990 



14,069 



Total cost of rations 

Average daily cost, each ration. 



15,597.14 
.397 



GENERAL TABLES. 

Table 28— DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES 
FOR EMPLOYEES. 

ABSOLUTE NUMBERS. 







Discharges from and 
deaths in hospitals. 


Total deaths. 


S « 


ill 

< 




M 

ii 
SI 

!1 
> *• 
< 


2 


i 
5 


a 


■i 

o 
H 


i 

a 


OQ 

1 
a 


■91 

IS- 

ii 

Q 


Year 1930: 

White 


3,589 
11,935 


1,123 
2,547 


1,034 
2,145 


89 
402 


29 
151 


27 
148 


2 
3 


19,949 
64,451 


54.65 


Black 


176.58 






Total 


15,524 


3,670 


3,179 


491 


180 


175 


5 


84,400 


231.23 






Year 1929: 

White 


3,505 
12,688 


1,066 
2,400 


956 
1,952 


110 

448 


27 
141 


23 
128 


4 
13 


23,861 
66,184 


65.37 


Black 


181.33 






Total 


16,193 


3,466 


2,908 


558 


168 


151 


17 


90,045 


246 70 







ANNUAL RATE PER 1,000 BMPLOTBBS. 



Year 1930: 

White 




312.90 
213.41 


288.10 
179.72 


24,80 
33.68 


8.08 
12.65 


7.52 
12.40 


.56 
.25 




15.23 


Black 




14.80 








Total 




236.41 


204.81 


31.63 


11.59 


11.27 


.32 




14.90 








Year 1929: 

White 




304.13 
189.16 


272.75 
153.85 


31.38 
35.31 


7.70 
11.11 


6.56 
10.09 


1.14 
1.02 




18.65 


Black 




14.29 








Total 




214.04 


179.58 


34.46 


10.37 


9.33 


1.05 




15.23 









105 



106 



CO j; 



E 

_c 

3 
1 

c 

i 

-a 
1 

M 
t 


°aMou)( 


1 " 


.. 


" " 






c» 




N — 


M 




■* 


•^ 




" 




~ 




•>f 






CM 








ajn 


n 


« 
















- 






c^ 












c 




«_ 




SI "AQ 


2 ""2 


— •« 


•n — c<-H —N 


»oeo 


03 


.*~ — 


— U5.-.NC10 — 


- 


si-oi 1 " 


— 
















- 






" 












- 












01-8 










" 














































8-Z 


























































i-9 
























































9-s| 
































" 








" 












S-* 












































" 












{--£ 


































- 






















K-Z 




























- 


























s-i 


























;- 






" 








" 






- 




>> 


•UM0U3( 

-un 














- 




























" 












S/-99 1 •" 

1 








« 


- 


-' 










CO 




., 


















': 


fi9-9f '^ 


" 




- 


"--' 




- -^ : 




c<» 


c.- 






- 










- 


5s-ie 1 '=^ 


N 


rt ■ ^ c^ 








- 






- 


- 






-■^ 








-- 


oe-91' 




- -- 






«« 


- 


_^ 


«-^ 








CO 


- 


'- 


p> 


Sf-It 1 " 


« 




- 






- 


-^ 


-»• 




« 


- 








(>»« 


^ 




- 


0f'-9£ j "^ 


« 




- 




















- 




(M 


„«« 




fi£-I8 j 




IM — 




- 








- 


-^ 












- 










- 




0£-9Z " 


























- 












CO 












sz-iz 


























;- 
















e« 






-- 




os-ei 
























































^ 
3 


P^H 
























































- 


■JiaBia 


O rtio^M (O 


«-« 


-M CD M t>-i^ 


(O-H ec*-" 




rt .W-H<M W^- 


« 


"3*!1M 


e^ 


- 




— m 


-- 






-^ 


•"- -- 


- 






;" '- 


■8q?Bap|B?0X 53 -.2-"=^" =* - «="-- -<o «t~^-t-«0ON ---U5^(M«,..-- -r 




15 


'a 

S 

ja 
H 


i 

1 

c 

1 

3 
-< 


1 

> 
> 

c 




.1 

eg 


Cancer and other malignant 
tumors of the stomach 
and liver 

Cancer and other malignant 
tumors of the peritoneum, 


a c 
1-5 = 

?i1 

i 


1 



E 

s 

-< 


I 

Q 


"S 

■£ 

> 

"c 

C 


O 

o 

»a 

■« 

00 

T3.S 


11 
111 

oc3 


a 
a 

a 
.52:5 

11 


1 
i 
1 
s 
I 
< 


1 
1 

1 


E 

E 

: 

-< 


J 


1 
6 


1 

a! 

.2 o 

a 


i 

c 


c 
E 

Z. 

c 

i 

c 

c 


'c 

o 
E 
g 
c 

1 


i 

■"c 


E 

a. 

1 

■€ 

"c 

1 


-5 

c 

1 

•< 




c 
c 

c 
c 

1 

c 


o • 

Is 
■i'l 

t 



107 






■3jn 



SI J3A0 '^ 2 



01-8 



s-i 



i-^ 



9-S 



1^8 



•ttsionj) 



59-95 



. lO •-* f-H ^^ C^ 



es-ie 



9f-\f 



0*-9g 



eg-i£ 



0E-9Z 



:« I 



P'H 



l~ 



■^o«ia "S 



^H lO C^ 1-H »-t C<l T-> CO ■■>-»« 



■»»!1Ai 



^H ■ ■ C^ 



•Bq^Bap |Biox '- 



^HOSCslt-i.-<CO^CCC^-HIM 



•S5 

= a.- : : g g-s 






108 



Table SO.-DEATHS AND DEATH RATES OF RESIDENTS OF THE CANAL ZONE AND THE CITIES 

OF PANAMA AND COLON. 



Place. 


Popula- 
tion. 


Deaths. 


Annual rate per 1,000 
population. 


Total. 


Disease. 


External 
causes. 


Total. 


Disease. 


External 
causes. 


Year 1930: 


74,402 
29,765 
39,469 


1,307 
518 
282 


1,251 
490 
242 


56 
28 
40 


17.57 
17.40 
7.14 


16.81 
16.46 
6.13 


.75 




94 




1.01 






Total 


143.636 


2,107 


1.983 


124 


14.67 


13.81 


.86 






Year 1929: 


73,000 
29,850 
38,825 


1.413 
492 
298 


1,370 
467 
263 


43 
25 
35 


19.36 
16.48 
7,67 


18.77 
15.64 
9.77 


.59 




.84 




.40 






Total 


141.675 


2,203 


2,100 


103 


15.55 


14.82 


.73 







no 



^co*^ -^ 



■ w^ eo • ■«co 



<-«»— -d^HO - c^i^ ■ ^ ^^ -^co eooowiO-- 



.^,-iC4 ■ c^ -H 



■ C^ - . ^H -N ^H ■ C^ 



<! 3 a 



• w^ -co •H ^H 



■ ^ OO -H 






• Oi O0Q»— <<;00i<M«--<"-0«-*i-*^-tC 



.^H^H -^^^-t -^ -CO^^ Oi'^r^ - C4 



■ O U3 ■ ^H C^ (M ^ lO 



■ c^eoc^ f— tuD.— iTj*.— (lo osco -•^C5i— 't-^D 



i,«co^^ .c^3,^_i,.^ ,-HfO'-«Nioec— •'-'t^'-«'^'-'»o ■^cc'-fio*— c^wO'-'— ^•—co 



•a 



,^ - . - - C X 

rs « =« M s-Tf ° 

?• ca c3 a cs g a 



;.2a 

lag 

• a j^ 



O 3 

a a 



■13=3 18 



tie '. _aJS 

. 60.2 - - 

'■Qja c c 
■ o -s « «t 

0-5 3 3 



CJJ2 3 



S.a.2 

o « c _ 



:a| 



sa 






^sa 



8 2.2 •.2.2-S-S.-2&°-S, 

oto = = s S.S- o rt.S J S 2 g g & g fe 5.2^-2 fe § 

cj u -^ 3 3 m S DO te ?"^-^ — ^ '^•-t^-D pO-Q S t^ £^ fc- _^ C 

J:5.S-M« >.>.>,g'bg-S>S:2-S-S 3 3 3 3 J fc S S;5 o 



a 

ill 



HI 



WD ^^ ft 1-H t—^^ ■ • 1/3 ^^ C^ i-H •— « CO -^ ■ ^H 



•^^ -lO ■ • -CO 



>»» rMMO 



IM <:0 (M 



'J' -CO ■ c^ 



> IC ■ •NOI'-IW - »-^ *** 



■V CSI C^ c^ M CO 



»0 ^* «0 Oi»-««— « CO CO t^ CO o 



■^H.— tcO»-HCO ^Ht^C^f— «f-HCO ■»«»— tOO»-HCO 



• -^ oo CO a> 



— ■<»> to 



■ ^ 00 ■ c^ 



■ wococo 



■«<< CO «-' lO c^ 



lO ■ - F-H CO 



■ ^H to -H Cfl -co 



lO (M • QO 



CI ■ ^H CO CO »o 



■rtlO^-'H 



CO »^ »-4 co^ 



CO Oi 00 t^ CO 1— » CO CO O CO "^ •-' *0 ■ CO F-* O 1-H rj« ^- O C^ W CI t^ ^H r- ■ «— ( to O d 






-- 


>o 


'-' 


IO-< 


CO-H ■ 


CJ - 


" 


■«•« 


" 


oc» '. 


■a, 


•rt r- 


-Hrt-H 


coooco 


00 


CO 


^ 


CO 


c^-* 


t~rtO 


OS^ CI 


-' 


CO —I 


w 


c^oo ■ 


-^ 


CO lOIN 


CO ■ CO 


CO 


00 



^H t^ CO ■ CO OO CO -COCICOCJ-^ 






3»-H CO^ CO-- 



»o 05 CI ^ *— t Tj" T}< o CO r^ •— ' »o «-- CO *o **• c^ CO 



COCICJCJCOI-^^Ht^^^C^iOCO^-'CO 



coco f^cq 05<M 



0*0 "S 



2 9° 

9 0a 



c c c 

M bD 5b 



:t3 >-a 

? CIS a J- i: 

; c3^ c8 ^ca 






"'£ a 

■a >> S? 



H 3 S O O ^ 

".2 c3 S S § 



. a 



5g| 

S"c3 C 



o o o o-o I 
■g-^-g-^cS g 
■- ca c3 c3'oj3 

c g G 33 g;2 g^ I 2 g S^'S 



'S.O & 

p a Q. 



'I 2 

■ o"o 



C3 -S 



-S E o S 03^ B-- PS ■ 5 53 
S °3-a^ rt c3^ o,-, &-S^ 






a a o-§: 






a o C C^ C H 



112 





S 

a 

-§ 

'i 

03 


i§ 
Otsi 






















o 




OS 






















" 








« 


'' 








r- 


w 


'^ 








o 
■< 

C 


J 
O 


(MN • 










^^5-2"' 


--.NC^ « 


co-H : 


c^ S'"'" 




iO(M«3 ■ 








CO-H — N — 


nmm 


2 


Tj-M 


rt-HC^ 


—I-* 


-«-*cooo • 


05 








^§1 






















" 


'^r 












-* 












— 




















o 


o 


'^ 


















« 


CO ■ 








'- 










-^ 


















-'-' 






o 
o 


to 


^ 






^ 




CO 




— 


•*CO 










" 




























N- 




CO 

< 


o 
1 




-* 










'- 




to 


oco 


















o 








'=^'--' 


-'-" 








"^" 














-H t- 


■a<u3 
















««« 


— 










^NCq 








o 
>** 
1 




N 






'^ 








'^ 


OU5 — 




— T- 


" 




-HCO 






lO 






(MWCO 






o 
-a 
o 
a 


7 








« 












t^ 


«« 










^H -^ 




CM-HW 












coe^w 






Q 
Z 

Z -S 
-^ c 

§ 1. 
o 


o 






- 














oo 


05r-H 










« — 














Cd 






U3 










o 






















CO 


^N 


































-«co 










>o 














«5 






■>r 


mco 


(M 


" 














« 


s- 








-^ 
























00 


'J^ 


in.-i loio 


«rH 








'^ 






^- g 












^ 


" 




>; 






















CO 


N 


















































o 


pa 


-H-*-*— .03 


CO t^ •-I CO --H ^-H -H CO to ^ 

toc^ 


t^'S'OOC^ CO 03 ^^ .-1 -N ^H 00 O ^H w 


^ 


iMm 






-iM 






tO^H OitO 






C^ 




'^ 


W ^H W 




^ ^ 






'^ 


CO 






Z 

u 


cc 


fe 


-H<M 


-^ 




(MC0<M^HO^<N!0^ 
— . to (Mrt 




." 


COCQ «w«^u5rt ^lO 
«3 


.'-' 


(Mt1< O 






a 
o 
z 

Q 
53 

cd 
o 

CO 

w 

< 
C 
J. 
« 

a 

•4 

H 


s 


^(M— 1— .rt -H.-irt(rq 


oo 


IPS— 1 


COW 


" 


>o 




b-T)<CO-^ OU3-^ 


•-« to TJ* to .-H 1-1 




^— ,„(Mrt « C<5 ■» T(" -H OO ■-< t- « —1 CO — TO »-l M t~ i-i-l QO m OO IM -* O i- -< — 00 00 C^ -H ,^ 




-o 

i 




: J 

3. 
5- 

36 


1 

3 

3 
3 

i. 


:' 
; 

r 

a 

Hl- 


; i 

-- 


^ 1 

3 1 

3 S. 

3 2 

i '^ 

3 g"" 

! ■ 

3 

5 c 


< 

a 

3 


5- 

3 


5 
3 


3 ; 

h 

5 1 
11 

3 

a - 
3 

5p 


3 

3 

3 

3 
3 

Is 

S c 
3 j 

5ff 


1 
J 


1 

3 C 

; E 

B 


t: 
t^ 

i 

£ 




3 

; 

[.' 


3 1 




3'- 

3 S 

3 




i 


■1 

I 

■ i 

. ■ 

: 

1 


■ 1 
\ 1 

^ i 
i « 

3 

$ a 


• 1 

: 1 

: i 

■ 

3 

3- 


3 
3 
9 
3 
3 
3 

3 

3 i 

'^ 
3'c 

5t 


: £ 

It 


i 
1 

3-0 


3.. 

r 


DO 

>, 

led 

•■| 

'■s 
: 4 
■ s 

:g 

; g 

'"o 

3 2^ 


1 
! 

3 


3 
>^ 

h 

3_' 
3 


3 

3 

3-^ 

; i 

3 ■ 
^1 

3 ! 
1 1 

^J 
! 1 

:: J 

3~- 

!' 

3- 
S 

h 


3 

§ 

i 

3 

h 
^tf 

= 1 

h 

«• 

a 
5p 


3 

1 

^° 

3 1 

't 

ii 
it 


1, 

3. 
3, 

5S 


j 

i 

A 

i-i 


1 

11 

\: 

i. 
3C 


y 

;! 

3 . 

ft 

3 

5« 


3 
3 
3 
£ 
3 

3 



113 



u^,-iC4,_ . cc 



00 *-• C4 ^H 1-t 



C^'-' Tp CO t— c 






^,^^^^<MC^.^ ^H .^ (M -H i-t 1-t 



ffO OCO^- i-* 



«!£)t^ .,-H-Hr-HeO .-H ■« *-( .-H (M ■>-< 



(N CO i-« ,-1 ^H M OO 



COM COl-Hl-H 



•* 


" : 


- S- : - 






" ; ; : ;-' : :'"■.:'-':■.'' ""^ : 


'^ 


'^ 


lO^ 


" 22 g''"'^- 






J -o «,- ,^,^ ■^.<N«> : f.«,c.^ 


-^ 



t~(M 


(M 


n 


-^ 


« 


o 


r^ 


•HCO>0 




— 


'- 


-^ 


"^ 






















" 


OJ 


■^ 




'-' 








^ 


M- 


„ 


>o 


00 


r^ 


lO COI^ 


„ 


^ 


,_, 


^ 




^^ 




^^ 


^ 




„ 


(MTX 


^ 


.-ir 




„ 




m 




„ 


,^ 














■* 















































o c 

C 3 



0-a300 



a g g aj 



•S3' 



^-1 >>s 









:l.^il1.| initio t: 

i 6 a<'(&(£'OMO<;tilra mz6 



O C3 



g ° - ^ u ►, 

■§ g g'-g g i-^S. 
372-^ S3 ""ca- 



"S'S 3 ""S 3 3 3 
HOSOO^PhO. 



3 °--a 

3JS 



114 



o 

< 3 



rn 




H 








H 


W 


O 


o 


H 


H 


W 


Q 


H 


rn 


n 


M 


z 


ei 


■«! 


Po 


W 


O 


!?; 




o 




M 




^ 




5z: 




-«! 




O 




pi) 




n 




H 





■ oo ■ «-«c^ — « 



&r 



eo*^4c o -c^ 



ooeoo-*^w3 oo c^ 



1-H lO ^ ^H 



■ w^'Wt*^'^ w^C^ 



"^C^C^QO ■ oo -Ht^^H 



.c« ^C<l^ 



1 :0 C4 .-H ■^ CD M* ^^ oo 

CO ^ OOtM*-* 



M — < ■ c^ 



oo C^ W5 00 1— < t-» 



1-ii-H.— I -.-teoc^O'-'tD t-HOs»^ 



00 c^c^ 



CO CM oo -«*''* < 



i-H ■ OO-H COC^ CO^ CO ccoo^^ 



4 Tj* CD ^J< — 00 



•^^H--«00'-H-OW3CO'— ••■ 



^^ CM -^ 



■g a 



3 o 






lll^ll 

M E-^ i fc! fe 



O 6f1 



ir - i; bC H 

a o_qa_ 
, >• ca c c8 



I fiC I 



bci 



s 



[2 S £'« S'-S 
S ^ gjcl 3 5 =« 
„ ^ ^ >> ^. ^. 



aa 



,;5 -ia js .;^ p;3 -;= ^ u oj o o x « o 



115 





ION 




















CO 




•M 




§5 






CO 






-HCOCO-H 




-«<c<i— .ira 


"3 


-HO 


IM 


" o 


— -■ 








-' 


'- 






































-''^ 






!>. 
























(M 








oa 










^ 




'^ 






«<i— 1 






cq 




>o 


" 




-^ 


'^ 




N 




N 


>o 




-J. 






— — r- 








-" 






s 

■M 




COC^M 


-.(MIM- 


-^ 






"^ § 




(M 










N 








— 


CO 


CO 




(N 






















— — 


C-l 




■<*< 




















— « — 


s 




















-Hi~q 


CO-CO 




























-^ 






CO 


•—lO 


CO — — cowN-Hco t~r^<Mo:. 






«oco 




-N-.- 






-H — IM 


OS 




»« 








— CO-H-HIN eoc<l(M>o 


oo 


^HSOfMCO-HCq-^J-CCC^ 


^ ^C--!0 


<M 


1-H -H M CO -H (M lO «3 CO — ' CO I^OSCOt-H 


o 


1 
2 

t 



■ 1 

il 

y 

5 i 


( 

T 

ij 

;i 

It 
3 ' 

1 "^ 


3 ■] 

3 J 

5k 


'ft 
t 

I'c 
3,1 


) 
■ a 

3 § 
:t 

? ! 
4"^ 


1 

3 > 

1 a 

w 

'A 


5 

C 

a 
£ 

E 

fi 
C 
■t 

'c 
c 

1 

in 

2^ 


! 

d£ 

•> i: 

1-1 

ji 


I 

j 

• - 

M 


h 

h 

3 J 

5c 


. 1 

■s 

■ "S 

3 -i 

a T 


1^ 


I 

c 
c 


c 
'S 

1 

'e 

■J 

1 

[\ 




e 





116 



■ COCSI-H . M 



)>C-^iOrt 



■ ^H ^^ ^H 1^ O ■ (M -H »-« CC C^ ■ ■ CO ^H ^^ ^H <-l ^H 



■ ,-1 ,-H ■ . ^H .-. (M (M i-t ^ 






H CO CO C<J • IC 






I^HC3i:O^HU5(M^H»C»-l.-(^H<M^^— Ht^»-<(Ml-HC^Tj<-^C^^Ht^rH.^.^^H^H-H.-H-<J<^-^H^H^H^^^H^H.— .-rCO 



rt 3 c« 



C c ^ 
£> O I" 



'o'o'o 



o >.-c;-E 



2.2 






; « >^ >i flt q5 3 3 z: 

iKQQiJE-.E-E-'H 






— C — li 

■? § ag"§ 



■" *^ o 
'o'o'S ='3 

2 2 ° a o 

a a s I a 

3=3 35 3 



B a 

o) a .. 

c c c 



a 5 s 

tC ** M 



^ J3 J3^ J= 

o o o o "o 

•T3-o-o-a-a 

§■- c c c a c 
03 cj rt CS C4 



c e s B 

>.g£ 1 1 1 1 1 
-e £^ itc B B c g 



r^i: 3-s «^ e"s H 

B S-S-^S > (D S-B 



S fe O'g" 



.2 a 



bE-^.2 



3 o a fe 
aWcco 






: 3 M 

i<6 



117 



• ^ ■ ■ 1-1 ■ i-> -co 






■CO ■ ■■•-I 



,rM - ■ ^ -.*<^H ■ « 



..^ . -c^ ..^ 



■CO ■ ■ (N 



•'-H • ■iOl-'T-l - -T-l 



»— I ■ ■vHOSCO - >— • C^ CO c<i C^ ^ c 



1 --I - -co 



• iO(M ■ -c^eo • ■ -i-tcfl 



■■— IM CO^fMi-H i-H 



. ,-< rH t-- 00 lO '-' '-' 



.(M,_,,-(i-HCqO'-H--('FH.-H: 



1-ti— ii-4C^OuD.-lCOCOCOC<|iD'^C^CMf 



as 



3 <D S o a 



b23 



• 3-0 

■'"OtS 

■«a'S 






.^ ^ "^ 



1^ _C3 't- 



- on ^ 0. a. g-5 

■ c 53 . m-o c.So..- W^ -is fe =« fe S oj 
2 .- g >. »? ^ „, S "-3 9 .. t: s ^. S ?^ £ 






5 o .-g ^ s " 2 .= o >. g r^ ~ -p S?^ 5 r 

_ S-S^ S 3 K ® tl-5 cn_S 3 t. O^-r^ 



O. (- ft ci, 



<a3 
>> >. 

as 
I a 1:2 

? 3 3 " 



•43 >> >, >> 



;ai 



Ci si a ^ "g 

c "S 'c c o|2 

-3 -6 -6 -S -S -rt -S §3 



&&M1-S M^S^^3S:23 



-S t; o g5-S5 fi c-2 u O) -*5.£5:^.i3:t3 oj:3 >iC3i3'ij >>3^ 3 3 =« w oJS'3'3'3 S o w o 3 ca 

QpqHjeL,mP)W<i;Q<;WMao3<;o<';ci&,oa30til&HOCL(pHa<<oSa3a3cc<:-<-^'«-<>j 



^ag-S 

S O 0_!, 



O ft 

.2^ 



118 



Table 33.-STATISTICS REGARDING AMERICAN EMPLOYEES AUD THEIR FAMILIES, 1930. 



Annual 
death rate 
per 1,000. 



White employees from the United States: 

Disease 

External causes 

Total 



6.29 
.60 



Families of white employees from the United States: 

Disease 

External causes 



Total . 



White employees from the United States and their families: 

Disease 

External causes 



6.89 


2.88 
34 


3.22 


4 11 
.43 



Total . 



4.54 



Nimiber of American children born on the Isthmus during the year 177 

Deaths among American children under 1 year of age 7 

Infant mortality rate among American children (number of deaths per 1,000 live births) 39 . 54 

Table 34— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1930. 









Employees. 


Nonemployees. 


Non- 
residents. 


Disease. 


White. 


Black. 


White. 


Black. 


WTiite. 






Mili- 
tary. 


Others 


Black. 


Epidemic, endemic, and infedious diseases. 
Typhoid fever 


13 

2 

. 1 

646 

375 

1 

1 

2 

4 

86 

2 

11 

26 

6 

4 

4 

3 

15 

39 

4 

33 

1 

4 

104 

18 

16 

1 

1 

108 


4 




1 

1 


1 


3 


8 


4 
1 




Paratyphoid fever 










1 
38 
28 










2 
1 


51 

84 


202 
70 

1 


77 
82 


274 
103 


6 
8 




Malaria, tertian 


1 
















1 

1 
1 
8 
1 
3 
11 
2 
1 

3 

1 
2 






Malaria, type undetermined 












1 








2 






1 
32 
1 
8 
12 
3 
2 

2 

" 3 








45 


1 




























Diphtheria 








2 

r 




1 








1 




Influenza, with pulmonary complications specified . 
Influenza, without pulmonary complications 


1 
1 


1 
















1 
1 

39 


1 
4 




Dysentery, amebic 


1 


1 


4 


1 














1 
17 

1 

1 
26 

4 
11 


3 

7 








1 


7 




1 


2 










5 
1 






4 
2 
10 

1 


3 

25 

1 


1 






" V 1 
4 
1 


52 

1 






1 


























1 
12 






48 
4 


16 


35 


19 


30 

1 
1 

2 

1 


44 

3 
3 

1 
1 

3 




Tuberculosis of the meninges and central nervous 




Tuberculosis of the intestines and peritoneum. . . . 


4 
3 
2 

3 

4 






































Tuberculosis of the bones (vertebral column 














Tuberculosis of the lymphatic system (mesenteiic 
and retroperitoneal glands excepted) 






1 




3 







119 



Table 34.— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL. 1930— Continued. 





H 
II 


00 

-a 
"5 
o 
E- 


Employees. 


Nonemployees. 


Non- 
residents. 


Disease. 


White. 


Black. 


White. 


Black. 


White. 






Mili- 
tary. 


Other 


Black. 


Epidemic, endemic, and infectious diseases. — Contd. 
Tuberculosis of the genito-urinary system 


3 












2 
1 
5 
2 

85 
4 
8 
7 

13 
1 

34 

'"'5' 
9 


1 




Acute disseminated tuberculosis 


3 

"26 
2 
3 
3 


" r 

2 
5 
3 

1 
10 


2 

13 

4 

107 

7 
1 
6 
36 
6 
106 
7 


;■ : 






36 

24 
211 

25 
6 

22 
131 

23 
304 

21 
7 

18 
1 
1 

13 
3 
1 
1 
1 

9 

4 

4 

22 
9 
2 

18 

81 

4 

9 

1 

1 

1 

52 

1 

3 

11 

10 

27 

1 

2 


11 
11 
21 

9 


2 


4 
5 
5 
2 








Tertiary syphilis 




Hereditary syphilis 






8 
42 

8 
84. 

6 


2 
4 
1 
21 
4 
2 
9 


1 
23 

6 
43 

2 






3 




1 






13 
2 


3 










Gonococcic vaginitis 














Gonocoocic bubo 






1 








Gonococcic salpingitis 










1 
7 
4 






Other gonococcus infections 


1 
3 




1 
1 


2 


2 

1 
1 

1 


2 










Filariasis 




























1 

3 

1 




General diseases not included in above class. 

Cancer and other malignant tumors of the buccal 
cavity 

Cancer and other malignant tumors of the stomach 
and liver 

Cancer and other malignant tumors of the periton- 
eum, intestines, and rectum 


11 

5 

1 


1 
2 


1 

7 
1 


1 


2 
3 


1 
4 
5 

17 

7 


1 


Cancer and other malignant tumors of the female 
genital organs 




5 
3 
1 

6 
11 

■■■] 


1 




Cancer and other malignant tumors of the breast . 


2 

10 
■■3' 


1 

1 

6 

14 

2 
2 


20 

1 
1 










Cancer and other malignant tumors of other or 
unspecified organs 

Benign tumors and tumors not returned as malig- 
nant. (Tumors of the female genital organs 
excepted) 

Ariitp rhpiiinat.ie. fever 


6 

21 
5 
1 


2 
5 


1 




1 










3 








4 

1 

21 






Rickets 















5 


4 


11 
1 


1 


18 


2 










1 

2 


1 

■■■■4 
4 
1 




1 

1 

3 

15 


2 
8 
3 
3 








2 




2 










3 


2 


1 










1 


r 


1 
2 










4 




1 
1 
1 
1 
3 








2 
27 
11 
8 
3 
3 
4 
87 




1 
2 

" r 
1 
2 










11 
1 


7 
3 
2 
1 


4 
4 

2 


2 

2 
















1 
1 


















2 

2 


2 
44 

1 










2 

4 

1 
1 
15 

1 
2 


3 


3 


36 

3 
1 
2 
6 
1 
9 


1 




Diseases of the nervous system and of the organs 
of special sense. 






1 
3 
7 
1 
22 


1 














1 


1 
8 








1 

1 


7 
1 
11 












Hemiplegia 






3 





120 



Table 34— DISCHARGES AND DEATHS IN HaSPITALS OF THE PANAMA CANAL, 1930.— Coatinued. 





I 

11 


•a 

o 


Employees. 


Nonemployees. 


Non- 
residents. 


Disease. 


White. 


Black. 


White. 


Black. 


White. 






Mili- 
tary. 


Others 


Black. 


Diseases of the nervous system and of the ortjans 
of special sense.— Continued. 


8 
18 
128 
25 
4 
2 

60 

21 

10 

5 

2 

40 

36 

20 

4 

2 

46 

78 

4 

64 

43 

22 

13 

182 

173 

7 

7 
4 
3 
123 
4 
93 
17 






4 
11 

7 

" r 
1 
4 
1 
2 


"37 
5 
1 

"24 
3 


2 
3 

16 
7 

" 1 
8 

5 


2 
25 
65 
9 
2 






General paralysis of the insane 

Dementia precox 


22 

1 


■3' 


1 
4 

1 






















3 


16 
12 
8 
4 

2 
4 

7 
1 
2 


5 








Convulsions (nonpuerperal; 5 years and over) 

Infantile convulsions (under 5 years of age) 
















1 














...... 

2 








11 
3 
4 


13 

1 
2 


4 
6 
3 


7 

17 
10 
2 
1 

15 
18 
2 
6 
3 
2 
3 

19 

38 

2 

1 


















2 
■ 1 


3 

6 

11 












■ 3' 

1 

19 

8 

5 

3 

44 

15 


5 
31 

"is 

14 
2 
4 
37 
60 
2 


18 
13 

1 

15 
13 

9 

2 
64 
40 

4 

3 
4 


2 
3 
















' r 
1 

5 

1 

■■25' 
3 

7 

■■■'2' 


5 
2 
2 
1 
8 
12 


4 
3 
2 


















10 
9 












Diseases of the circulatory system. 


2 

"1 
15 

2 
13 

5 

1 
16 

5 


4 
1 

2 

46 

3 

34 

2 

1 

31 

5 

4 

2 


2 


















15 


25 


40 
2 

42 
5 


5 


2 








2 
1 


6 
1 


3 
3 














160 

21 

8 

7 

4 

9 

177 

17 

6 

13 
117 

54 

300 

14 

247 

59 

1 

65 

167 

6 

47 

2 

2 

1 


63 

" 1 
2 


17 
3 
3 

'"'2' 
2 
19 
3 
2 

1 
38 

11 
117 
2 
71 
17 


26 
6 


6 
2 


1 











Phlebitis . . . 




1 

1 


2 
1 
1 
33 
4 
1 

3 
23 

6 
71 

1 
61 

3 












2 

35 

5 

2 

7 
35 

1 
30 

3 
52 

5 


4 

59 

4 

1 
4 

24 
46 
4 
18 
16 






' r 


13 

1 
1 

1 
12 

9 
33 

2 
30 
14 


16 


•> 












Hemorrhage without specified cause. (Non- 


■ 6' 

3 
2 
1 

13 
4 








Diseases of the respiratory system. 




Other diseases of the nasal fossae and their annexa. 
Diseases of the larynx 


i 

1 




2 






Broncliitis, unspecified (5 jrears and over) 


1 


22 

32 
2 


5 
9 


2 
59 

2 
16 

1 


5 
4 

1 
6 


30 
20 
2 
5 


44 

105 

2 

15 


1 

1 
1 

r 






1 
















1 




1 




2 








1 






1 
1 


1 
9 












53 
5 


10 
2 


6 

1 


9 
1 


17 
2 


2 




Other diseases of the respiratory system (tubercu- 
losis excepted) 





121 



Table 34.— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1930.— Continued. 



Disease. 



Employees. 



White. 



Black, 



Nonemployees. 



White. 



Mill- I Black, 

tary. Others 



Non- 
residents. 



White. 



Diseases of the digestive system. 

Diseases of the teeth and gums 

Stomatitis 

Other diseases of the mouth and annexa 

Adenoid vegetations 

Other diseases of the pharynx and tonsils 

Diseases of the esophagus 

Ulcer of the stomach 

Ulcer of the duodenum 

Gastrectasis 

Acute gastritis 

Chronic gastritis 

Acute indigestion 

Other diseases of the stomach (cancer excepted) . . 
Enteritis, colitis, or entero-colitis (under 2 years 

of age) 

Intestinal autointoxication (under 2 years of age) . 
Enteritis, colitis, or entero-colitis (2 years and over) 
Intestinal autointoxication (2 years and over). . . . 

Ankylostomiasis 

Cestodes (hydatids of the liver excepted) 

Nematodes (other than ankylostoma) 

Other parasites, specified 

Parasites not specified 

Acute appendicitis 

Chronic appendicitis 

Hernia 

Intestinal obstruction 

Other diseases of the intestines 

Cirrhosis of the liver, not specified as alcoholic . . . 

Biliary calculi 

Abscess of the liver (unqualified) 

Cholecystitis 

Other diseases of the liver 

Peritonitis without specified cause (except 

puerperal) 

Other diseases of the digestive system (cancer and 

tuberculosis excepted) 



Nonvenereal diseases of the getiito-urinary 
system and annexa. 

Acute nephritis (including unspecified under 
10 years of age) 

Chronic nephritis (including unspecified 10 years 
and over) 

Pyonephritis 

Pyelonephrosis 

Pyelitis 

Hydronephrosis 

Movable kidney 

Other diseases of the kidneys and annexa (puer- 
peral nephritis excepted) 

Calculi of the urinary passages 

Diseases of the bladder 

Stricture of the urethra 

Other diseases of the urethra, urinary abscess, etc. 

Acute prostatitis 

Chronic prostatitis 

Abscess of the prostate 

Hypertrophy of the prostate 

Other diseases of the prostate 

Hematocele 

Hydrocele 

Other nonvenereal diseases of the male genital 



82 
24 
12 

5 
1,576 

2 

20 
49 

3 

35 
35 
19 
53 

20 

5 

240 

40 

195 

3 

23 

6 

1 

189 

107 

207 

4 

328 

5 

17 

2 

53 
19 

24 

1 



129 
5 



Cysts and other benign tumors of the ovary .... 
Salpingitis and pelvic abscess (female). Not 

gonococcic) 

Benign tumors of the uterus 

Nonpuerperal uterine hemorrhage 

Dysmenorrhea 

Cervicitis 



7 

1 

1 

33 

46 
42 

160 
64 
12 
29 
65 



34 

5 

103 



297 
1 
3 
15 



113 
13 



109 
28 
44 



19 
11 
2 
4 
392 



40 



18 

10 

3 

1 

708 



7 

2 

1 

22 

20 

37 

2 

106 

1 

3 



7 
29 

137 
56 
3 
12 
38 



122 



Tabli;34.— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1930.— Continued. 



Disease. 



Employees. 



White. 



Black. 



Nonemployeea. 



White. 



Mili- 
tary. 



Others 



Black, 



Non- 
residents. 



White. 



Black. 



Nonvenereal diseases of the genilo-urinary 
system and annexa. — Continued. 



Endometritis 

Prolapsus uteri 

Lacerations, old or recent, of cervix and perineum . . 
Benign tumors of the female genital organs 

(except of uterus) 

Other diseases of the female genital organs 

Nonpuerperal diseases of the breast (cancer 

excepted) 



The puerperal state. 



Abortion (miscarriage, premature birth, etc.) 

Ectopic gestation 

Other accidents of pregnancy 

Puerperal hemorrhage 

Cesarean section 

Other surgical operations and instrumental 

delivery 

Other accidents of labor 

Puerperal septicemia 

Puerperal albuminuria and convulsions 

Following childbirth (not othervrise defined). . . . 
Puerperal diseases of the breast 



Diseases of the skin and of the cellular tissue. 



Gangrene 

Furuncle 

Acute abscess 

Trichophytosis. . . .' 

Scabies 

Red bug 

Elephantiasis (nonfilarial) 

Myiasis of the skin 

Dhobie itch 

Prickly heat 

Ulcer of the skin 

Impetigo contagiosa 

Impetigo simplex 

Urticaria 

Eczema 

Ingrowing nail 

Other diseases of the skin and annexa. 



Diseases of the bones and of the organs of locomotion. 



Osteomyelitis 

Periostitis 

Other diseases of the bones (tuberculosis excepted) 

(Sinusitis also excepted) 

Ankylosis 

Arthritis 

Synovitis 

Other diseases of the joints (tuberculosis and 

rheumatism excepted) 

Other diseases of the organs of locomotion 



Malformations. 



Early infancy. 



Congenital debility. (-1 yr. only) 

Icterus of the newborn. (-1 yr. only) 

Mulnutrition. (-1 yr. only) 

Other diseases peculiar to early infancy(l yr. only) 
Premature birth. (-1 yr. only.) 



33 

8 

25 

8 
140 

29 



4 

65 

305 

56 

9 

1 

1 

4 

2 

5 

31 

10 

2 

6 

7 

27 



34 

7 

13 
10 
108 
19 

12 
148 



Congenital malformations of the heart . . . .' 

Other congenital malformations (stillbirths not 

included) 137 



22 



123 



Table 34— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1931— Continued. 





'^ So 

11 


"i 

•a 

3 
o 


Employees. 


Nonemployees. 


Non- 
residents. 


Disease. 


White. 


Black. 


White. 


Blacli. 


White. 






Mili- 
tary. 


Others 


Black. 


Early infancy, — Continued. 


6 


7 
2 

3 

2 










13 

2 

9 

7 






Other diseases peculiar to early infancy. (-3 mo. 














Old age. 
Senility 


37 
5 

2 


4 


18 




9 












External causes. 








2 








1 
1 










1 














1 






Attempted suicide by cutting or piercing instru- 


1 






1 










1 






1 
1 
1 
5 
17 










7 
6 
23 
56 
1 
1 

13 

65 
164 

28 
8 
1 

79 
4 
3 
3 
8 

11 
2 
3 
6 

3 
5 
140 
19 
18 
531 

42 
18 
13 

1 

121 

894 
925 
546 


"2' 1 


1 

3 
6 
6 


2 
1 

10 

22 

1 










1 






Other acute accidental poisonings (gas excepted) . 
Accidental burns (conflagration excepted) 


4 
5 


1 
2 


5 
11 






3 
















1 




Accidental traumatism by firearms (wounds of 


1 






9 

5 

26 

5 

3 


2 

3 

19 
1 

1 


3 

11 
45 

2 




Accidental traumatism by cutting or piercing 




44 

42 

15 

4 


2 

17 
1 






2. 
■ 1 


15 
3 

1 


2 




1 








1 
15 








7 


14 


27 
3 

'" r 
4 
4 

" r 


15 

""2 


15 
1 
















1 












2 
1 
5 








" r 


2 
1 






1 






3 

1 


















2 






1 




3 


1 


3 




Attempted homicide by cutting or piercing instru- 




2 

1 

13 
2 

"228' 

12 
2 

1 


1 

"19 

1 

4 

34 










■■'56' 
10 
2 
90 

14 
5 

2 


2 
13 

'"'3' 
37 

6 
4 
2 


1 

32 

4 

3 

104 

9 
4 
9 


1 




2 
■ 3 

3 


5 

2 

6 

34 

4 
1 

2 

1 


4 


Dislocation 










7 


Ill-defined diseases. 
Ill-defined 






1 
1 


1 


Infection of undetermined origin 


1 






Normal physiological conditions. 






48 
249 
268 
225 


72 
642 
656 
116 


1 

3 

2 

37 


















1 










No disease (companion, observation, etc.) 


34 


6 


127 


1 


Total 


15,460 


532 


1,129 


2,453 


2,406 


3,371 


5,633 


918 


82 







124 



o 

m 

Q 
c 
'S 

a 


5 


§ 






" 


;5 


03 


" 




pooc» 


oo 


N 


« 


— 




o»o 




CD 






CD 
<3> 


OS 




U5 

■* 


CO 
CO 


g 


to 

00 




^1 


r- 




n-JS 


to 




£S2§ 


^ 


CO CO 


'^ 




cq 


CO CO • 


CO 


OS 


O CMOO 

crs « -«j* 


§ 


^1 




oo 


<M 




. 


-HIO 


^ 






COCOr- t^ 


f~ 






CO'* 


•-H CD 


s 


c 




S 


TO-J-iO 


o 


" 


ot^ •' 


^ 


C^ CO 
(M 


CO 


— . OS 


s 






CO 


^ t^o^ 


OO 

CO 




CO 


00 ■ 


= 


« 






as 




CD 


rl -^ 


CD 




(N 


CO 






OS 


— . CO 


CO 


H 


tOiO 


■aoo 


o 


C^(M 




CO 


'^ 






— S"*« 


?3 






<M irs 


OOCO 


00 


s 


5 


o 




>o 


»o 


oot~e^ 

COIMIM 


C<1 

CO 




^^ 


CO 


£?S 


CO 


« CO 


■^ 


00 

CO 

1 




CD 


3 '53 


g 




t^oo 

<N1 


>o 






o 


U5 


■iO 






"'J' 


M* CO 


o> 








o 


o oo-< 


OS 






t^ tn 




00 t^ 

CO 


^H CM 


CO 






c^ioSco 


i 








(M OS 

oo-a> 
C'i' 


»0 OS 
CM O 

CM 


CO 
"5 


S 


1 


en 


^ c5i^ 




- 


00 CBN 


o 




C-) 


" 


J::S 


2 


COT- 


■* 


■«** 


M t^co 

CO lOOO 


5 


■§.2P 


■<i^ 




^M 


^ 






CO 




o 






IM 


t— 1 1^ 


■* 


'"' 


*"* 


CO 


t^ t~^ 


CM 

CO 




O-H 


■^f t-^ 


- 








■; 


T-H 






CO»i3 (N O 


o 

(M 








CO CO 




ts 


t 

'a 




o 

o 




"a' 


s 


O5CO00 


oo 




UO 


coos 


•^ 


COCQ 


00 


g 

w 


C^ k^ CD 
Y-^ C3S03 


00 
00* 


1-^ 
^1 


N 


ooo 


i 






co^^ t^ 


- 


rt CO 


OO 


ss 

N 


CO 


CO ■ 


CO 


i 


CO osos 


■* 
o_ 
cm" 




gg 




'^ r^ 


cc CO 


tP 






OiCM r^oo 

■>J.^0OOO 


CO 
CO 








OS-W 
OOIO 


Kg 


I3S 

o 

OS 

•o" 


o 
>. 

3 
B 

•-5 

c 
'c 

§ 


•3 


I 


COOl^ 


03 


^ 




R 


■>»< CO 


w 


oo 




K?5 


CD 


o 

CO 


^ 2S 


i 


II 


<» 


-^ 


^ 


'"* 


CO C5 00 


■* 


CO •* 


r** 


-HO 


%n 


": 


' 


- 


s s§ 


OS 




00 to 


^H TT 


CO 


— -(t 




"* 


o> 






<MO«00 


^ 








rt o 


(MCO 


1 




c 
o. 

c 
o 

1 

i 

O 


3g 

II 


i 

< 


;1 

' i 

id 


5 

3 
1 

i- 


o 

< 


o 


'o. ' 
o 

o 


:2 

It 
5-1 


;1 


i 
■l 


l< 


o 


c 
c 


■a • 
c • 

C3 ■ 

"si 
a s 

)0 


3 1 

3 


< 




c 

< 




c 




O ] 

Or 

" c 

o.'i 

O 

0. 


i ; 

3 • 

I >. 
i'S 
2S 




o 


2 

< 


ia 


: OS 

;s 

:fl 

- c 

CS 


o 


1 





125 



Table 36— NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED AND AVERAGE NUMBER IN 
HOSPITAL EACH DAY OF THE VARIOUS CLASSES OF PATIENTS, 1930. 



Class of patients. 



Gorgas Hospital: 

Employees 

Army and Navy 

Panamanian Government. 

Charity 

All others 



Total. 



Corozal Hospital: 

Employees 

Army and Navy 

Panamanian Government. 

Charity 

All others 



Total. 



Cripples 

Chronic medical and surgical cases. 



Colon Hospital: 

Employees 

Army and Navy. 

Charity 

All others 



Total . 



Palo Seco Leper Colony: 

Panamanian Government. 
Canal Zone Government . . 



Total. 



Total by classes: 

Employees 

Army and Navy 

Panamanian Government 

Canal Zone Government, charity, 

cripples, and chronics 

All others 



Grand total . 



Number of days treatment. 



7,540 
31,904 



2,847 
14,257 



56,548 



276 
1,351 



55 
2,016 



.1,150 

7,460 

854 

4,240 



13,704 



8,966 
40,715 



3,756 
20,513 



73,950 



Foreign. Black. 



4,017 



1,048 
15,813 



20,974 



365 



33,006 
3,315 
7,065 



43,751 



1,095 
1,866 



580 



344 
2,911 



3,835 



645 



645 



4,962 



33,747 



7,668 
25,789 



72,166 



34,572 



732 

6,089 

45,060 



86,453 



7,391 



134,546 
14,304 
25,172 



181,413 



8,718 
17,244 



3,413 
14,331 



Total. 



46,129 

31,904 

828 

9,984 

75,130 



163,975 



8,032 

1,351 

167,552 

17,674 

34,253 



228,862 



9,813 
19,110 



7,605 

7,460 

4,611 

21,482 



41,158 



27,340 
8,117 



35,457 



47,838 



162,618 



57,885 
84,563 



352,904 



27,985 
8,117 



36,102 



61,766 
40,715 
196,365 

69,309 
130,865 



499,020 



Average number in hospital each day. 



can. Foreign. Black. Total. 



20.66 
87.41 



7.80 
39.06 



154.93 



.15 
5.52 



10.13 



3.15 
20.44 

2.34 
11.62 



37.54 



24.56 
111.55 



10.29 
56.20 



11.00 



.26 

2.87 

43.32 



57.46 



90.43 

9.08 

19.36 



119.87 



3.00 
5.11 



.94 

7.97 



10.51 



1.77 



13.59 



92.46 



21.01 
70.65 



197.71 



94.72 



2.01 

16.68 

123.45 



368.62 
39.19 
68.96 



497.02 



23.88 
47.24 



16.09 



9.35 
39.26 



64.71 



74.90 

22.24 



97.14 



131.06 



445.53 



158.59 
231.68 



126.38 

87.41 

2.27 

27.35 

205.83 



449.25 



22.00 
3.70 
459.05 
48.42 
93.84 



627.02 



26.88 
52.35 



20.83 
20.44 
12.63 
58.85 



112.76 



76.67 
22.24 



98.91 



169.22 
111.55 
537.99 

189.89 
358.53 



1,367.18 



T.4BLE 37.-CONSOLIDATED REPORT OF ADMISSION, HOSPITALS AND DISPENSARIES, 1930. 



All classes of patients. 


White. 


Black. 


Total. 


Admissions to hospitals, excluding Corozal farm (cripples and chronic ward) 


7,916 
2,637 


8,527 
. 3,209 


16,443 
5,846 








10,553 


11,736 


22,289 






Less number of patients transferred between hospitals and from quarters to 


246 


374 


620 








10,307 


11,362 


21,669 






Employees only. 


1,172 
2,637 


2,579 
3,209 


3,751 




5,846 






Total admissions of employees 


3,809 


5,788 


9,597 


Less number transferred between hospitals and from quarters to hospitals, whose 


49 


190 


239 






Net admissions of employees 


3,760 


5,598 


9,358 




1,047.65 


469.04 


602.81 







126 



AVERAGE NVMBBR OF DATS IN HOSPITALS AND QUARTBB3 FOB BACH ADMISSION, EMPLOTBBS ONLT. 





White. 


Black. 


Total. 


Hospitals: 


12.51 
8.78 


20.70 
10.64 


18 04 




7 23 








11.88 


18.55 


16 47 






Quarters: 


2.52 
1,62 
2.38 
2.75 
3.46 


4.10 
2.88 
3.06 
4.96 
8.61 


3 50 


Balboa .' 


2.11 




2.72 




3.99 




6.99 








2.28 


5.18 


3.87 







MR 26916— Panama Canal— 1-16-32— 1,000